Physical Therapy Forms
Forms for Ellen Roth, PT:
Thank you for choosing to see me for your physical therapy needs! I am attaching some paperwork that I would like you to fill out prior to your visit: it’ll save us time when I see you! Please 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. A written report will be sent to your physician and you will also receive a copy. Subsequent visits will also be about an hour each time. 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 and helping you on your way to wellness!
| Patient Registration Form |
| Patient History Form |
| Patient Consent Form |
| Financial Policies Form |
| Insurance Benefit Worksheet |
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 |
| Subjective Intake Questionnaire |
