Powers Physical Therapy, LLC

Powers Physical Therapy will be closing December 1st, 2020

Forms for New Patients

For Medicare Patients ONLY:

For Non-Medicare Patients:

Medical History Forms

Medical History

Patient Registration Form

Patient Registration

Patient Registration Form

Patient Registration

Consent and Financial Policy

Consent and Financial Policy Form

Optimal Instrument Form

Optimal Instrument

Consent and Financial Policy

Consent and Financial Policy Form

Medical History Forms

Medical History

Privacy Practices

HIPPA Statement

HIPPA Statement

PDF versions of new patient forms can be downloaded from the desktop site