© 2018 by Lesley Powers, DPT.

 Powers Physical Therapy, LLC, 1247 Washington Road, Suite 28, Rye, NH 03870

Forms for New Patients

For Medicare Patients ONLY:

For Non-Medicare Patients:

Medical History Forms
Patient Registration Form
Patient Registration Form
Consent and Financial Policy Form
Optimal Instrument Form
Consent and Financial Policy Form
Medical History Forms

Privacy Practices

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