Patient Forms

Intake Form

This form asks of your general information.

New Patient Packet

This document contains all forms you need as a new patient. Individual forms are available, as well.

Release of Information

This form authorizes the release of necessary information to your insurance company for the payment of the services rendered.

Assignment of Benefits

This form provides your physical therapist with further information concerning your insurance policy.

Pre-Examination Form

This form provides your physical therapist with information concerning your medical state and history.

Pain Report Forms

Disabilities of the Arm, Shoulder & Hand

Oswestry Disability Index for Back Pain

Upper Extremity Functional Index

The Lower Extremity Functional Scale

Neck Disability Index