Please download, complete, and return via email or in-person at your evaluation.
CONSENT TO TREAT
Consent to treatment is the agreement that an individual makes to receive medical treatment, care, or services, including tests and examinations. Anyone who can independently decide whether they want treatment must provide consent. This form also covers photo/video consent and payment/cancellation policies.
The Health Questionnaire is designed to gain pertinent information about each patient's prior medical history, allergies and current medications, as well as provide detail on the current case. It is a screening tool utilized by your provider to determine risk of "red-flag" conditions that might deem referral to another medical provider.
DIRECT ACCESS/MEDICAL RELEASE
A medical release form serves as an authorization for the physician or doctor to share the patient’s medical information to a specified person stated by the patient. In this case the form provides the provider with contact information for the patient's primary care physician should your PT need to communicate case findings or receive a signed Plan of Care from him/her.