Customer Documents

 

PHYSICAL THERAPY: Patient In-Take Forms These forms should be signed prior to Physical Therapy treatment.
PHYSICAL THERAPY: Insurance Reimbursement Info INFORMATION ONLY - Please review important information about your insurance reimbursement and our company policies.
PHYSICAL THERAPY: Notice of Privacy Practices INFORMATION ONLY - Important information about our company's privacy practices.
PHYSICAL THERAPY (post): Quality Assurance Survey We want to hear the voice of whom we serve...you! Please complete this questionnaire when you have completed your therapy and turn it into your therapist or mail it to our office.
PHYSICAL THERAPY (post): Patient Results Form We want your referring physician to know how you've improved! Please complete this open questionnaire after completing your therapy and turn it into your therapist or mail it to our office.
MASSAGE THERAPY: Consent Form All Massage Therapy patients / clients must complete this form prior to the initial treatment.
WIKI WIKI / BEYOND RX: Atletika Consent Form All Beyond Rx, Wiki Wiki Fitness, Personal Training, Sports Enhancement and Martial Arts clients must complete this form prior to the initial session.
Authorization to Disclose Medical Information Please have the patient complete this document when requesting medical documents to be released to an entity other than the referring physician or the patient's insurance carrier(s). Other documents may be used in leiu of this form, such as patient signed requests from attorney offices.
POLICY AGREEMENT: Physical Therapy Additional information regarding your specific plan will be added to this document and presented to you for review at the time of your Initial Evaluation.