Registration Forms

Registration Forms

Welcome and thank you for choosing us to be your physical therapy provider.

We realize that filling out paperwork is time consuming. However, we need to have these forms filled out and returned to us before you see your physical therapist.

We have made every effort to minimize the paperwork required for our patients, while also getting the information we need to provide you with the highest quality service possible.

In order to make better use of your time at our clinic, we have provided you with registration forms to be printed and completed prior to arriving at your first appointment. The forms included in this registration packet enable us to learn about your condition and how it affects your daily life, understand your overall health, and track the effectiveness of your rehabilitation.

Step 1) Fill out our Patient Information Form: Click here

Step 2) Choose one form below for Functional Diagnosis (See options below):

In addition to the Patient Information Form, from the list below please print and complete the form for the body problem area that best describes your issue(s):

English:
Lumbar = Middle to Lower Back
Cervical = Neck to Upper Back
Upper Extremity = Shoulder Elbow Wrist Hand
Lower Extremity = Hip Knee Ankle Foot
Other = ?

Spanish:
Lumbar = Centro y abajo en la espalda
Cervical = Cervical (Spanish)
Extremidad Superior = Hombro Codo  La Muñesa  Mano
Extremidad Inferior =  ?
Otro = Problemas en varios partes

You will receive a copy of our Notice of Privacy Practices from the front desk, or you may print it here:

English:  Notice of Privacy Practices
Spanish: Aviso Sobre Las Prácticas de privacidad
English:  HIPPA Medical Release Form

Please complete all forms. Return them to us with your insurance card(s) and Photo I.D. on or before your first visit. If you have any questions regarding these registration forms, please give us a call at 779-6146, or send an e-mail to contact@medfordsportsinjury.com