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Forms – New Patient Registration

Completing necessary forms in advance of your appointment will help you save time. They also help provide useful information to our therapists and improve your recovery and outcomes.

Please download and fill out forms completely before your first appointment. Please print completed forms and bring them to your first appointment.

  Required Forms

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New Patient Registration

It is not necessary to complete this form If you have completed intake information via WebPT.

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Administrative Policy

It is not necessary to complete this form If you have completed intake information via WebPT.

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Social Health / Misc. Health History

Please review and complete before your first appointment.

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Consent for Treatment of Minor

Please complete if the patient is a minor, < 18 years old.

  Additional Forms

Please only complete the forms below as directed by your Doctor of Physical Therapy

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Cleveland Clinic Incontinence Score

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Fear Avoidance Beliefs Questionnaire

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HOOS JR

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KOOS JR

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NIHCPSI_Female

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NIHCPSI_Male

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Pain Catastrophizing Scale

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Pain Disability Index

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Patient Specific Functional Scale

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Pelvic Floor Impact Questionnaire

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Pelvic Girdle Questionnaire

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Vulvar Pain Questionnaire