At ACIC Physical Therapy we realize that your first visit to a physical therapy clinic can be intimidating, especially when you don’t know what to expect. To make your experience with us easier and more comfortable, please read the following recommendations. Should you have any questions about the following, please do not hesitate to contact your respective clinic location.

For Your First Visit With Us:
• You will check in with the receptionist
• Bring the necessary patient forms to expedite records processing
• Bring your insurance card
• Dress in loose, comfortable clothing that is suitable for exercise
• Be sure to select clothing that will allow for easy access to your problem area
• Expect to be with us for close to two hours for your initial visit. This will allow for adequate time to assess and evaluate your current condition and begin the appropriate treatment.

Prior to coming in for your first appointment with us, please take a moment to fill out the necessary forms in order to expedite the implementation of your physical therapy treatment. All new patients should complete the Patient Information Form, Medical History Form, Consent to Treatment, Functional Chart, and the specific form that corresponds to your problem area. In addition, please print out and sign the Financial Policy Form and Missed Appointment Policy. If you are a Workman’s Comp case, please also complete the Workman’s Comp Form. Bringing these completed forms with you to your first visit will enable us to serve you in a more timely fashion. Thank you, in advance, for your cooperation. We look forward to working with you.

*Note: - The Medicare Form should only be completed by individuals with Medicare coverage.
- If you are the parent of a minor who is receiving treatment with us, please also include the Minor Patient Waiver. Thank you.


Patient Information
Functional Chart
Worker Comp.
Missed Appointment Policy
Financial Policy
Medical History
Minor Patient Waiver
Medicare Beneficiaries

DASH
Back Index
Neck Index
Lower Extremity Functional Scale