New Patient Forms

Required Forms

Registration And History Form (Front)

Registration And History Form (Back)

Medical Records Release (Please sign and date this form; the therapist will fill it out during your evaluation if any medical records are needed)

Consent Form

HIPAA Privacy Statement (This form is for your information only and does have to be turned in)

Our Payment Policy (FYI) (This form is for your information only and does have to be turned in)

Optional Forms

Parental Consent Form (Minors Only)

Registration Form-Front (Minors Only)

Registration Form-Back (Minors Only)

Accident History Form (Private Insurance Cases Only)

Workers Compensation History Form (Workman’s Comp Cases Only)