Patient Forms
Thank you for choosing Gainesville Physical Therapy & Wellness. It is our personal goal to make the process from start to finish as smooth and enjoyable as possible. One simple way to do this is for you to have the necessary information and forms already filled out at the time of your initial visit.
Therefore, we ask that you please print and fill out the intake forms listed below.
Thank you again for choosing Gainesville Physical Therapy & Wellness, LLC where you truly matter and obtaining the results you want are as important to us as to you.
Intake Forms
- Patient Information (New patients and returning patients if information has changed or not been in the clinic for over one year)
- Patient Medical History (New and returning patients to fill out)
- Patient Health History (New patients and returning patients if information has changed or not been in the clinic for over one year)
- Notice Of Protected Health Information Practices (All patients read only)
- Policy And Procedures For Intake (All patients read only)
- Patient Insurance Verification Questionnaire(Not required)
- Fear Avoidance Questionnaire(all cervical/neck and back patients please fill out)
- Referral Form
Targeted Therapy Forms (please fill out all that apply)
