Patient Forms

Please complete the following forms online prior to your appointment. Please click on the appropriate link below. You will be redirected to our secure Electronic Medical records and this will allow you to complete the forms online, eliminating the need to do them all by hand.  This makes sure we have the most accurate information, and it saves you time filling out forms when you get to our office!

Forms by Insurance Type

Please choose the appropriate intake form packet below, and after clicking on the link, please fill out the forms online. Please note: If you have Medicare as a primary OR secondary insurance source, we’d like you to complete the Medicare packet.  Thank you!

Click here to access forms if you use Medicare

Click here to access forms for other forms of insurance

 

Other Forms You May Be Asked to Complete

Depending on your injury or problem, you may be asked to fill out one or more forms, to help the Physical Therapists learn more about you and the particular problem that has caused you to seek treatment.

Are you experiencing Dizziness or balance issues?  If so, please also fill out this form

DASH– internal diagnostic form 

LEFS- another special form

NDI – specialized assessment

Low back pain? Please fill out this assessment as well- Oswestry Low Back

Foot and Ankle Measure (FAAM)

Knee Outcome Survey (KOS)

ABC Scale (Balance)

Fear Avoidance Questionnaire