Patient Information Forms
It is helpful to complete these patient forms prior to your initial evaluation appointment. Please bring them to your appointment along with your insurance card and a prescription from your doctor if needed.
- New Patient Form
- Consent to Treat Form
- Medical History Form
- List of Medications
- Financial Policies Acceptance Form
Notice of Privacy Practices
This document outlines our policies concerning your private health information. Please read it carefully.
If you have scheduled a free injury screen with one of our therapists, please complete this form.
Please note: Many insurances also require additional patient forms or patient surveys to be completed via email or while in our office. We may request that you fill out additional paperwork upon arrival or periodically during your course of therapy. Please arrive 10 minutes prior to your initial appointment time. The above forms can be filled out on your computer, but due to privacy policies they cannot be sent back to our office electronically. Please print the forms after completion and bring them to your first office visit.
Landmark Physical Therapy utilizes FOTO® Outcomes Measurements to prove our clinical quality. Focus On Therapeutic Outcomes, Inc. (FOTO®) is a nationwide outcomes database for medical rehabilitation providers. By participating, Landmark Physical Therapy compares our performance data to the other progressive organizations across the country who are part of the FOTO network. Confidential patient surveys are one of the ways we collect this valuable data.