Forms

Medical History Form

• Please print this “Medical History Form” prior to coming and complete at your convenience. 
• This form is required for all patients for each episode of care. 
• If you are a former patient who is returning for a new episode of care, we thank you and appreciate you completing this form again. 
• If you are unable to print and complete it, please arrive 20 minutes early to do so at the clinic.  
• The therapist may need to inspect and provide direct treatment to the injured region. Please wear comfortable clothing with an ability to expose the area if necessary. There is a private room available for changing.