Patient Forms

The link below will provide you with our patient forms. Please print these out and complete them before you come in for your first visit.

All patients please fill out:

• Patient Information Form
• Notice of Privacy Rights & Acknowledgement

All spine patients please fill out:

• Duffy-Rath Questionnaire® - for back and neck patients to fill out the day of their 1st (and each follow up) appointment

If you have Medicare, please fill out:

• Notice of Exclusions from Medicare Benefits

If you are coming to physical therapy because of a motor vehicle accident, please fill out:

• New York Motor Vehicle No-Fault Insurance Law Assignment of Benefits Form

All patients attending physical therapy for Vertigo or dizziness please fill out:

• Vestibular History Form

All patients attending physical therapy for jaw pain please fill out:

• TMJ History Form

[Printable Version]