In preparation for your first appointment with Professional Physical Therapy, please print the Patient Forms below. Complete the forms at your convenience, and remember to bring them with you to your first scheduled visit.

These editable files can be filled out digitally, but you are required to print them out and sign them.

If you prefer, you may print the forms and fill them out by hand.

Along with these forms, you should also bring:

  • Your Physical Therapy prescription, if applicable
  • Your insurance card or case number
  • Any relevant diagnostic reports you may have (for example, X-ray or MRI)

 

Patient Intake FormFormulario de ingreso de paciente nuevo

 

Patient Medical HistoryFormulario de antecedentes médicos del paciente

 

Notice of Privacy PracticesAcuse de recibo del aviso de las prácticas sobre la privacidad

 

Patient Notification Policy and ConsentPolítica de notificación al paciente y consentimiento

 

Physical Therapy Attendance PolicyPolítica de asistencia

 

Electric Stimulation Pad PolicyPolítica en cuanto a la almohadilla para estimulación eléctrica

 

Medication List for Medicare PatientMedication List for Medicare Patient Spanish

 

Notice of Privacy Practices Acknowledgement FormAcuse de recibo del aviso de las prácticas sobre la privacidad

 

Direct Access - New YorkNotificatión de aviso - Ley de acceso directo - Nueva York

 

Direct Access - New JerseyNotificatión de aviso - Ley de acceso directo - New Jersey

 

Direct Access - ConnecticutNotificatión de aviso - Ley de acceso directo - Connecticut