Patient forms and your first visit
Print and complete these forms before your first visit and bring them with your physician’s prescription and photo ID.
Before your first visit
A completed copy may be faxed, mailed or hand delivered to the clinic. Please do not email forms.
Fax (610) 624-1324
- New patient formsFor your convenience, you may print and complete these forms before your first visit.Download PDF
- Revised telehealth consent formComplete this if you will have a telehealth visit.Download PDF
Please fill out the survey for your problem area
Please fill out the appropriate survey before your first visit.
- Low back painOswestry low back pain questionnaire.Download PDF
- Neck painNeck pain questionnaire.Download PDF
- Arm, shoulder and hand functionQuickDASH outcome measure questionnaire.Download PDF
- Lower extremity functionLower Extremity Functional Scale.Download PDF
For your physician
This copy may be faxed, mailed or hand delivered to the clinic. Please do not email the prescription.
- Prescription formFor your physician to complete and send to the clinic.Download PDF
Our monthly newsletter
A short read for patients on staying healthy and active.
- The Therapy ConnectionMonthly patient newsletter (PDF).Read the newsletter
For your first visit, please
- Bring your referral slip or physician’s prescription
- Bring your medical insurance card and photo ID
- For a workers’ compensation claim or an automobile accident, bring your claim information, including the claim number
- Arrive 15 minutes early to fill out paperwork
- Wear comfortable clothing, such as sweatpants or shorts, a T-shirt or tank top and sneakers. Your first evaluation lasts about 60 minutes