Patient Forms

Because we are dedicated to providing you the best physical therapy solutions, we are now making our patient forms available online for downloading and printing. Below are the links to all of the forms that are required prior to your appointment as well as a few other forms/documents. Simply click on the link, print the form using your printer, and fill in the appropriate information, and you're on your way to an even more convenient appointment.

To view these forms, you will need Adobe Reader. Please download the appropriate software necessary so that you can print and fill out your forms prior to your first appointment.

New Patient Required Forms

Financial Policy / Consent to TreatTodd Loehrke, DPT and Pat Schuh, MPT lead a Volleyball Injury Prevention Seminar at Players Choice of Little Chute.

Intake Form

Notice of Privacy Practices

Summary Notice / Written Acknowledgement of Receipt

Other Forms/Documents

Medical Record release to OST

Medical Record release to PATIENT or OTHER FACILITY/AGENCY

spacer
Copyright © 2010 by Orthopedic & Spine Therapy. All rights reserved.
 
dummy