Patient Forms
Print Forms
Below is a link to a packet of forms that you will need to fill out prior to being seen. If you print them and complete them prior to your appointment, it will make the check-in process quicker. We always recommend that new patients arrive 15 minutes prior to their first appointment.
The following forms are NOT REQUIRED for your first visit. If needed please download
Privacy Practices (HIPPA) - this is our policy of how we protect your private information and medical records. This is a Federal Law requirement that all health care practices conform to.
Medical Records Release Form - this is used when you want us to send your records to yourself or another professional (i.e. attorney, physician, etc.)
Prescription - please download and print one of these prescription forms for Physical Therapy to take to your physician if you need a prescription.
Financial Policy - please view our Cancellation Policy as it is your responsibility to know the limitations and restrictions of your insurance company regarding physical therapy.
Please call our Billing Office at (435) 635-9333 if you have any questions.
