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.

Spine and Sport Biomechanical Rehabilitation Center
  1. Adult Intake
  2. Medicare Intake 
  3. Minor Intake
  4. Re-Evaluation Adult Intake
  5. Re-Eval Medicare
  6. Re-Evaluation Minor Intake
  7. Good Faith Estimate
  8. Authorization to Treat a Minor
  9. Cancellation Policy
  10. Subjective Pain Questions
  11. Re- Eval Subjective Pain
  12. Subjective Pain Questions- Child
  13. Lower Body Medicare
  14. Lower Body
  15. Upper Body
  16. DASH
  17. Headache Intake
  18. Shingles Questionnaire
  19. SCAT- Concussion
  20. RSD & CRPS
  21. Check Test Log
  22. Notice of Privacy Practices
  23. Hotel Suggestions