Forms
On your first visit please bring these items with you:
- Photo identification
- Insurance card
- Prescription from your doctor
- The following three forms (please fill out before your first visit)
Policies And Patient Responsibilities
Notice of Patient Information Practices
5. Choose the Outcome Report as requested by our office.
Dizziness Handicap Inventory - Initial
Foot and Ankle Ability Measure - Sports Subscale - Initial
Hip disability Osteoarthritis Outcomes Score - Initial
Knee injury Osteoarthritis Outcomes Score - Initial
Lower Extremity Functional Scale - Initial
Lymphedema Life Impact Scale (v2) - Initial
Modified Falls Efficacy Scale - Initial
Modified Oswestry Low Back Pain - Initial
Neck Disability Index Questionnaire - Initial
Pelvic Floor Distress Inventory Short Form 20 - Initial
Upper Extremity Quick DASH - Initial
If you would like our team to coordinate care with another physician practice please complete the form below to authorize release of your medical records