Forms & Insurance


In order to help us expedite your initial visit and better serve you, we ask that you please bring the following completed forms to your first visit:

1) Patient Information Record

2) Cancellation policy

3) Please complete the form related to the part of the body for which you are seeking treatment. If you are unsure of which form to complete, please call our office for assistance.

a. Neck Pain – Neck Disability Index form

b. Upper Back, Shoulder, Arm, or Hand Pain – Disabilities of the Arm, Shoulder, Hand (DASH) form

c. Low Back Pain – Oswestry Disability Index form

d. Leg Pain – Lower Extremity Functional (LEFS) Scale

e. Swelling of the Arm – Disabilities of the Arm, Shoulder, Hand (DASH) form

f. Swelling of the Leg – Lower Extremity Functional (LEFS) Scale

g. Breast cancer – Disabilities of the Arm, Shoulder, Hand (DASH) form


Our physical therapy sessions are routinely covered by Medicare and private insurance companies. We are happy to assist you with understanding your specific physical therapy benefits and financial responsibilities based on your insurance policy.  Please call with any questions; we are here to make your experience as easy and worry free as possible.