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.
Print Health Progress Result Form