patient forms

A few things to remember before your appointment at Spine & Sport
  • Always arrive 15 minutes early to allow time to get you ready before your appointment
  • Bring all required new patient forms fully completed
  • Bring with you shorts and a t-shirt which is required for the evaluation
  • Payment is due each time of service by cash or check only, we do not accept credit or HSA cards
Effective January 1, 2015: Patients may seek physical therapy services without a physician prescription for 21 days or 10 treatments, whichever occurs first. A prescription is required for all patients covered under Blue Cross Blue Shield, Messa, Medicare, Auto Insurance, or Worker’s Compensation.

  1. Adult Intake
  2. Medicare Intake 
  3. Minor Intake
  4. Re-Evaluation Adult Intake
  5. Re-Eval Medicare
  6. Re-Evaluation Minor Intake
  7. Medicare Cap Notice
  8. Authorization to Treat a Minor
  9. Subjective Pain Questions
  10. Re- Eval Subjective Pain
  11. Subjective Pain Questions- Child
  12. Lower Body Medicare
  13. Lower Body
  14. Upper Body
  15. DASH
  16. Headache Intake
  17. Shingles Questionnaire
  18. SCAT- Concussion
  19. RSD & CRPS
  20. Notice of Privacy Practices
  21. Hotel Suggestions