We welcome the opportunity to help you improve your health and well being. We believe it is our privilege to assist you. We strive to provide excellent care and help you achieve great results.
In order to do so we have various forms and information for you depending on the type of services you may choose. Our staff is very friendly and willing to assist you. We look forward to helping you!!
What To Bring To Your Appointment
Please bring your insurance card with you so we may copy it for our records.
Please bring your doctor's referral for physical therapy, unless it has already been sent to our office.
Please bring any medical reports, such as notes from your physician, X-ray, MRI or other special test reports if available.
Please wear or bring comfortable clothes to change into for the evaluation. Shorts are preferred for knee and ankle evaluations. Sleeveless or halter tops for females for shoulder evaluation. Comfortable exercise or walking shoes are recommended.
Download the following forms and complete prior to arriving for your first appointment to speed along the process!
(All files are in Microsoft Word format.)
Patient Medical History
Patient Health Insurance
Billing Policy and Authorization
Authorization form for MPTSM Billing Policy.
Cancellation and "No Show" Policy
Consent for Use and Disclosure of Health Form
Notice of Privacy Practices
Patient Contact Information
In order to better meet your needs as well as maintain confidentiality, please let us know how we may contact you, regarding cancellations, scheduling appointments and other information that may be personal in nature.
Neck Index (Word)
Back Index (Word)
Lower Extremity Functional Scale (LEFS) (Word)
Disability of Arm Shoulder Hand (DASH) (Word)