Patient Forms
The link below will provide you with our physical therapy patient forms. You can print these out and complete them before you come in for your first visit.
- Patient Information & Health History Form
- Patient Insurance Verification Form
- Patient Self Insurance Questionnaire Form - This form is a tool for you to use to call your insurance company to verify your physical therapy benefits.
- Notice Of Privacy Practices
- Financial Policy
- Service Agreement
Please choose ONE of the following four functional outcome measurement forms to complete before your first visit:
- Neck Index (this should be used if your problem relates to any of the following: neck pain, mid back pain, cervical spine problems, headaches, and thoracic spine problems, pain and/or numbness radiating into your shoulder/arm/or hand, and jaw/TMJ problems).
- Low Back Index (this should be used if your problem relates to the lower back).
- Upper Extremity Index (this should be used if your problem relates specifically to your shoulder, elbow, wrist or hand).
- Lower Extremity Functional Scale (this should be used if your problem relates specifically to your hip, knee, ankle or foot).
Fitness Program Clients click here.
