Forms

Required forms for your first appointment:

Please print the following 5 forms, complete & sign, and bring them to your initial appointment.
 

Patient Registration

Physical Therapy Consent-Waiver

Financial Agreement

Medical History

Dry Needling Consent

 
Full Policy (do not print): Notice of Privacy Practices

 

FUNCTIONAL OUTCOMES:

Low Back Pain Index

Neck Pain Index

Lower Extremity Index (Hips, Legs, Knees, Feet)

Knee Pain Scale

Disabilities of Arm, Shoulder and Hand

Dizziness Scale

 

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Other Forms  (not required):

Release of Medical Records

Patient Summary