Forms for Ellen Roth, PT:
Thank you for choosing to see me for your physical therapy needs! Below is the paperwork that I would like you to fill out prior to your visit: it’ll save us time when I see you! Please print out & bring the papers with you when you come, and bring clothes to change into that will assist me in being able to see the body parts that I’ll be evaluating: shorts & (for women) a swimsuit or sports bra, preferably one where I can still see your spine. The first visit will be primarily an evaluation and will last about an hour. Subsequent visits will also be about an hour each time. Please remember to bring a method of payment: I accept cash, checks, and credit cards. I do tend to get booked up, so it’s a good idea to schedule out a number of appointments: with the online scheduling it’s easy to cancel 24 hours in advance. I look forward to seeing you to help you resolve your body’s limitations/complaints!
| Patient Registration Form |
| Patient History Form |
| Patient Consent Form |
| Financial Policies Form |
Forms for Suzanne Oliver, PT:
Thank you for selecting Kinetic Elements Physical Therapy for your care. Please, print off and bring in the completed forms on your first visit. If you are unable to print off the forms, please email or call me to arrange for the forms to be available for you 15 minutes prior to your first visit. The first visit will primarily be an evaluation and each visit will last about one hour. Bring or wear clothing that will allow me to see the body parts that need evaluation. Shorts and for women a swim suit top or sports bra work well. It is best to schedule several appointments to ensure continuity of care. The online schedule system allows for appointment changes up to 24 hours in advance.
I look forward to meeting you and helping you on your way to wellness.
| Patient Registration Form |
| Notice of Privacy Practices Form |
| History Intake Questionnaire |
Forms for Kateryna Bakay, PT, MPT, OCS:
Thank you for choosing Bend & Stretch Physical Therapy for your care. Please, print off, fill out, and bring in the completed forms to your first visit. Wear clothing that will allow me to see the body part being evaluated. Each visit will last 55mins. Please call/text or email in advance to inquire whether I accept your health insurance provider. Remember to bring your insurance card with you to your first appointment and a method of payment for cash-pay option. I accept cash, checks, credit cards. You may book your appointment online via our online scheduling system. If you do not find the time that suits your schedule, please contact me and I will try to accommodate you if I can. You may change of cancel your appointment online up to 24hrs in advance. A fee of $50 will be charged for a late cancel or no-show (excluding emergencies). I look forward to meeting you and helping you achieve your fitness goals! Phone: 918-688-4403, email: bakaykat@hotmail.com
| Patient Registration Form |
| Patient History Form |
| Patient Consent Form |