Patient Forms

We would like to make your appointment as easy as possible. Please take your time filling out these forms. If you have questions in regards to which form to fill out please call us!

New Patient Intake Packets

Patient Intake Packet- Physical, Occupational & Hand Therapy

Patient Intake Packet- Pelvic Floor Physical Therapy (Females Only)

Patient Intake Packet- Pelvic Floor Physical Therapy (Males Only)

Patient Intake Packet- Lymphedema

Previous Patient Intake Update- OT/PT

Informed Consent Laser Therapy & Medical History

Consultation/Wellness Screen Form

Forms

Authorization Forms to Release Medical Records

Patient Request for Medical Records

Liability Waiver- Fitness Room

No Show/Cancellation Policy Form

COVID-19 Informed Consent & Wellness Screening

Notice of Privacy Practices

Physical Therapy Outcome Measure

Lower Extremity Function

Neck Disability Index

Modified Oswestry Disability Scale

Shoulder Pain & Disability Index

Dizziness Handicap Inventory

Occupational/Hand Therapy Outcome Measure

Pelvic Floor Outcome Measures

Pelvic Floor Distress

Pelvic Floor Impact Questionnaire- PFIQ

Initial Vulvar Pain Functional Questionnaire (V-Q)

Queensland Female Pelvic Floor Questionnaire

NIH- Chronic Prostatitis Symptom Index (Males Only)

Lymphedema Outcome Measure

Lymphedema Life Impact Scale- LLIS

Employee Forms

Time Off Request

Late CX/No Show Submission

Questions? 360-279-8323

become-a-patient

Laser list

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