| Referral Form for Physicians |
Patient Intake Form:
Please fill out the PDF document to the right for general information. Complete to the best of your ability. We will be able to assist you with any questions at your first visit.
| INTAKE FORM |
Patient Questionnaire Form
In order to serve you more efficiently, please print the form out to the right (Patient Questionnaire), fill it out and bring it with you to your first visit.
This form will provide the therapist valuable information that is essential to designing a treatment plan that is also part of your goals.
The form is 4 pages, so it will save you 10 minutes on your initial visit.
| Patient Questionnaire |
Preparing for Therapy
Be sure to bring the following with you to your first appointment:
1. Driver's License/Photo ID: this is required to verify that you are the same person as your insurance card.
2. Insurance Cards. We will need to make a copy of your insurance cards to allow us to bill your insurance unless you would like to pay cash and file your insurance yourself.
3. Money: You will be required to pay any co-payments or high deductibles up front at the time of service. Any unpaid portion (co-pay and deductible) will be billed to the patient at the end of their treatments.
4. Appropriate clothing: We will be needing to examine certain parts of the body that are affected by pain. Please wear loose clothing, bring or wear tennis shoes or something that will provide adequate support for your feet during exercise.
5. A great attitude. Only you can make yourself well. We are just guides and instructors to assist you to reach your potential. You will be required to perform exercises at home to continue to make progress in your recovery.
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Preparing for Pool Therapy
1. Bring comfortable clothing to wear in the pool. This can be a bathing suit, shorts, shirt, socks, sweat pants, etc. As long as they are not cut off they can get into our pool. Pick something that is easy to put on and take off while it is wet.
2. Bring aquatic shoes if you like. The bottom of the pool is like a hot tub, and is smooth. However if you have tender feet it may be worth the investment.
3. Bring a towel and anything that you may need to prepare yourself to leave (ex., blow dryer, shampoo, dry clothing.)
4. Do not bring any fear. The pool depth is 4 feet, has a hand rail to hold onto and the temperature is generally around 90 degrees. Most enjoy the exercise in the water, as exercise on land may increase pain in the joints.
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