Patient Forms

Required Forms

We encourage you to save time by printing out and completing these forms prior to your first visit.  Please arrive 15 minutes prior to your scheduled appointment time with the completed forms. All clients will need to complete three (3) forms in total.  Start with the medical history and consent to treat forms below. Then choose the functional scale form in the next section that relates to the area we are treating.

Functional Assessment Forms – Choose One

All clients need to read and complete one of these forms. Insurance companies are looking more closely at how your current problem is affecting your function to justify coverage. Please choose the body area your symptoms affect to complete a standardized functional assessment:

Medicare Clients

PLEASE BRING A COMPLETE LIST OF YOUR MEDICATIONS.  Medicare asks us to keep on file a complete list of your medications including dosage and frequency.

General Information

These final forms are for your information only. You do not need to print or bring them in with you.