Patient Intake Forms
If you are a new patient to the therapy department, the following forms need to be filled out prior to being seen by your therapist. You may choose to print the forms, complete them at home and bring them with you to your first visit. Alternatively, you can arrive 15 to 20 minutes prior to your scheduled evaluation time and complete the forms in the waiting room.
If you prefer to do this at home, please review our welcome letter and fill out the 4 other forms. Please remember to bring them with you the first day. Medicare beneficiaries will need to fill out 1 additional form in the office. This form is required by Medicare so we can track your functional progress.
If your forms are completed and you do not have Medicare, please arrive at or 5 minutes before your scheduled time.
If you have Medicare and have completed the forms at home, please arrive 5 to 10 minutes before your scheduled time.
If you have Medicare and have not completed the forms at home, please arrive 15 to 20 minutes before your scheduled time.
Thank you. We look forward to assisting you in your recovery.
- Welcome Letter
- Intake Form
- Medication List
- Consent to Release Information
- Financial Policy and Consent to Treatment