Forms

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Welcome to Active PT
The following forms can be printed out, completed and brought with you on your first visit to Active Physical Therapy. If you are not able to complete the forms before your first visit, please arrive 15 minutes early so you have time to complete the forms before your appointment. Thank you for your cooperation; you will soon be on your way to better health!

Office Policy
Thank you for choosing Active Physical Therapy. We are committed to the success of your treatment with us. We believe that by being informed of our services and policies, you will be more successful.
Download the pdf.

Functional Questionnaire
Read and download the pdf.

Medical Profile
Please fill out the following questionnaire as completely as possible. This enables your Physical Therapist to establish a clinical profile upon which a safe and appropriate therapy program is planned.
Read and download the pdf.

HIPAA Agreement
This notice describes how medical information about you may be used and disclosed, and how you can get access to this information. Please
review it carefully.

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