When therapy matters
Patient Forms
Thank you! Thank you! Thank you! My back pain of 10 years is now livable. When my pain management doctor suggested I see you I almost didn't go. I had already been to therapy elsewhere, had 2 surgeries and multiple injections with no relief. I am so glad I kept the appointment. You looked at my back and my activities in a way no one had done before. I will recommend you to others without hesitation.
--F.D.-- Lakeland
New Patients
We encourage you to save time by printing out and completing these forms prior to your visit.
Medical History- all clients to complete this form
Consent to Treat - all clients need to read and complete
Functional Assessment Forms - all clients need to read and complete. Insurance companies are looking more closely at how your current problem is affecting your function to justify coverage. Please click on the body area your symptoms affect to complete a standardized functional assessment:
HIPPA form - patient privacy form
Medicare Cap Information - information regarding limits on physical therapy services if you are a Medicare participant
4720 Cleveland Heights Blvd., Suite 101 Lakeland, Florida 33813
We encourage you to save time by printing out and completing these forms prior to your visit.
Medical History- all clients to complete this form
Consent to Treat - all clients need to read and complete
Functional Assessment Forms - all clients need to read and complete. Insurance companies are looking more closely at how your current problem is affecting your function to justify coverage. Please click on the body area your symptoms affect to complete a standardized functional assessment:
- neck
- back
- upper extremity (shoulder, elbow, wrist, hand)
- lower extremity (hip, knee, ankle, foot)
HIPPA form - patient privacy form
Medicare Cap Information - information regarding limits on physical therapy services if you are a Medicare participant
4720 Cleveland Heights Blvd., Suite 101 Lakeland, Florida 33813
