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.


Please fill out all forms in BLACK ink.

New Patient Packet

Minor Patient Waiver – For patients who are under 18 years of age.

Patient Medical History

ACIC HIPAA Release Form

Functional Assessment Tools.   Please choose and complete the form which is most appropriate for your current condition.

Back Index – For low back, lumbar patients.

Neck Index – For neck / cervical patients.

Disabilities of the Arm, Shoulder and Hand (DASH) – For shoulder, elbow, wrist, and hand patients.

Lower Extremity Functional Scale (LEFS) – For hip, knee, ankle and foot patients.