Patient Registration Form
Collects pertinent information to allow us to contact you and to bill for therapy services
Health History / Review of Systems Form / Condition Assessment Form / Condition Assessment Form
Collects necessary information to initiate evaluation process
Identifies and objectifies symptom type & location
Collects necessary information to facilitate determination of a therapy diagnosis
Release of Information and Consent for Treatment / Assignment of Benefits / Payment Guarantee Form / Notice of Privacy Practices (HIPAA Acknowledgement Consent) Form
Medicare Secondary Payer Form
In accordance with our goal to preserve an evidence based practice, you may have to complete additional functional activity form(s) to allow us to further diagnose your condition as well as facilitate future measurement of therapeutic outcomes.
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