Our office staff members are very friendly and are willing to guide you from your first phone call through the initial evaluation to your discharge day.
What do I need to bring with me?
On the first day, please arrive 15 minutes early so you can fill out the appropriate paperwork. you will need your insurance card, driver’s license, co-pay, and prescription (if applicable). For your convenience, we accept cash, checks, and credit cards, for your co-pay. Listed below are the forms that will need to be filled out prior to evaluation, please bring the completed documents with you or e-mail them to us prior to the session.
Can I refer myself?
Yes. In many cases, you can come "Direct Access" for an evaluation without first obtaining prescription.
All patient’s provide or complete the following forms:
- Past Medical History (Word)
- HIPAA Forms (Form 1 - Please Sign It, Form 2 - Please Read It)
- Consent Form (Word)
- Cancellation Policy (Word)
- Covid-19 Screening Form (PDF)
Functional Questionaires (Condition Specific)
Please complete one (Office Staff will tell you which one):
- Activities and Balance Confidence (ABC) (PDF)
- Dizziness Handicap Inventory (Word / PDF)
- Concussion (PDF)
- Neck Index (PDF)
- Back Index (PDF)
- Disability Arm Shoulder Hand (DASH) (PDF)
- Lower Extremity Index (PDF)
- Penn Shoulder Scale (PDF)
- WOMAC (PDF)
What To Wear?
Please wear loose, comfortable clothes and sneakers/tennis shoes for the initial evaluation and treatment sessions. You will be moving around throughout the sessions so the more comfortable you are the easier it will be. The evaluation will take about 60 minutes.
Due to our commitment to provide you one on one, individualized care, we request a 24 hour cancellation notice. A $45 fee will be assessed for no shows or lack of adequate cancellation notice. Thank you for your understanding.
Please complete once you are finished with services at our facility and either mail or e-mail to us. We welcome your feedback.
- Patient Satisfaction Survey (PDF)