Forms


Patient Forms for Landmark Physical Therapy

 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.

Notice of Privacy Practices

This document outlines our policies concerning your private health information. Please read it carefully.

Notice of Privacy Practices

Injury Screening

If you have scheduled a free injury screen with one of our therapists, please complete this form.

Injury Screening 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.

Physicians Prescription Form