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Forms

Instructions
We welcome you to TEAM Physical Therapy. Below are the forms that you will need to fill out and bring in with you to your first session with us. The forms are in Adobe PDF. (You will need the Free Adobe Acrobat Reader in order to view these forms. If you do not already have it, you can download it for free from Adobe here.) All of the forms are interactive, fillable forms. Just fill in the required information, click the Print button at the top of each page, and bring them with you when you come to TEAM.

Along with these forms, we ask that you bring your Driver’s License (or other Federal Issued I.D.) and Insurance Card.

Cash Patient

Team Physical Therapy: Welcome

Non-Industrial Injury Patient Information

Notice of Privacy Policies and Practices

Referral Questionnaire

 

Medicare Patient

Team Physical Therapy: Welcome

History and Physical

Notice of Privacy Policies and Practices

Medicare patient questionnaire

Non-Industrial Injury Patient Information

Referral Questionnaire

Lien Patient

Team Physical Therapy: Welcome

History and Physical

Notice of Privacy Policies and Practices

Personal Injury Lien

Non-Industrial Injury Patient Information

Referral Questionnaire

Sports Injury Screening

Team Physical Therapy: Welcome

Minor Consent Form

History and Physical

Notice of Privacy Policies and Practices

Sports Injury Screening Information

Non-Industrial Injury Patient Information

Referral Questionnaire

Private Patient

Team Physical Therapy: Welcome

History and Physical

Notice of Privacy Policies and Practices

Non-Industrial Injury Patient Information

Referral Questionnaire

Workers Compensation

Team Physical Therapy: Welcome

History and Physical

Notice of Privacy Policies and Practices

Industrial Injury Patient Information

Referral Questionnaire

Spanish Forms

Bienvenido a TEAM Physical Therapy

Informacion del Pacient No Industrial

Cuestionario de Referencias

Derecho de Retencion de Dano Personal

Aviso Sobre Polizas de Privacidad y Practicas

Historia Medica

Cuestionario de Riesgo de Caidas

Preguntas y Respuestas Sobre Danos Fisicos en Deportes

Informacion del Paciente Industrial

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