PLEASE CANCEL WITHIN 24 HOURS DURING BUSINESS HOURS IF YOU ARE UNABLE TO KEEP YOUR APPOINTMENT. We appreciate your cooperation in avoiding no-shows as we have other patients who would be grateful to take your appointment time. Thank you!!
Be sure to bring the following to your evaluation appointment:
- Legal photo ID or driver's license
- Insurance card(s)
- Prescription for therapy from your physician
- Your calendar of commitments so we can schedule future appointments
- List of surgeries, prescription and over the counter medications
Please print, complete and bring the following forms with you:
- Medical History Form
- Episode of Care
- Missed Visit Policy
- Authorization for Release of Private Health Information
- Acknowledgement of Privacy Practices
For Your Records:
Ladies only - Pelvic Patients please print:
- Pelvic History
- Pelvic Functional Outcome Measure
- Missed Visit Policy
- Authorization for Release of Private Health Information
- Acknowledgement of Privacy Practices
For Your Records:
*Medicare patients only: please print, complete and bring this form as well.
- Medicare Patients (Medicare patients only)
Functional Outcome Measure Forms:
We will advise each patient which of these forms are needed to print, complete and bring to the evaluation appointment. New insurance regulations require some of these forms to be completed.
