Functional Self-Report
We ask that you fill out at least one form about why you are coming to physical therapy. If you would like to work on your balance, please fill out at least one additional form, besides the balance form (Patients often choose the lower extremity form.)
Patient Demographics
Please fill out the top half of this form. We will let you know if we require additional information. Thank you.
Medicare Information
If you have Medicare, please read and sign this form. It will let you know what Medicare will, and will not, cover for physical therapy. Please note, that what Medicare does not cover is often covered, sometimes in part, sometimes in full, by one’s supplemental insurance.
Cancellation Policy
If you need to cancel or reschedule, we ask for 24 hours notice.
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