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Patient Intake Form

Orthopedic and Sports Physical Therapy Patient Intake Form

Medical History Form

Please provide us with your medical history and pertinent background information. This information will assist your physical therapist in providing a complete and thorough evaluation.



​​​​​What is Physical Therapy?

Physical Therapy is the health profession that helps patient’s recover from injuries, pain, and dysfunction by utilizing exercise, manual therapy techniques, and modalities.

How do I know if Physical Therapy can help me?

If you are in pain, have an injury, or physical dysfunction, scoliosis you would probably benefit from physical therapy.

What should I bring to my first visit?

Please bring the following to your first visit: a photo ID, health insurance card, prescription if you have one, x-rays / MRI reports if you have them.

What should I wear?

Please wear something comfortable, loose fitting clothes, shorts if lower extremity injury, tank top or loose T shirt if shoulder or neck injury, sneakers.

Will it hurt?

Physical therapy does not generally hurt and usually will provide pain relief. Exercises should be performed within pain free range, which encourage restoration of range of motion, strength and function. Certain injuries and condition may be a little painful when manual techniques are used but ultimately you will have pain relief and improved motion and function afterwards.

Does insurance cover my treatment?

Yes, insurance does reimburse for physical therapy but every plan is different. As a courtesy we will verify your physical therapy benefit for you.  

Do health insurance companies pay private out patient physical therapy facilities less?  

Yes!  Health insurance companies pay private practice a lot less (6 times less) compared to Hospital out patient facilities and large corporate owned physical therapy facilities.  

Will I have to pay more to go to privately owned physical therapy office seeing as they are reimbursed 6 times less?

No you are not responsible for the difference.  We have a negotiated contract (actually its dictated, take it or leave it contract) that does not allow us to get reimbursed any more and has actually cut our reimbursement 50 to 60% since 2004 without an increase.  You will probably pay less coming to a private out patient clinics.   

What type of payment do you accept?

We accept health insurance, credit, debit cards, checks, and cash.

What should I expect in my first visit?

On your first visit you will have a thorough evaluation and will also receive treatment. 

How long will my first therapy session last?

Depending on your injury, please allow 1 hour to 2 hours for your first visit and 1 to 1 ½ hours for subsequent visits. This can vary depending on the type and the extent of your injury.

How many sessions will I have?

How many treatments you will need depends on the type and severity of your injury or condition and how you respond to treatments.  Typically you will be seen 2-3 times per week for 4-8 weeks.  

What type of education and training does the therapist have?

Your physical therapist needs to have a physical therapy license in the state they are providing treatment. Physical therapy education requirements have changed over the years and physical therapy graduates since 2003 are required to have a masters or doctorate degree from an accredited physical therapy program. Prior to 2003 a bachelors was required from an accredited physical therapy program. Physical Therapists are required to take 30 hours of continuing education every 2 years.

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