Complimentary 15 Minute Physical Therapy Consultation - Call (503) 777-6746 Today!
As directed by our front desk personnel, please click on the links below to open the necessary forms in PDF format. Print the forms, fill out, and bring with you to your appointment.
1. Health Insurance Advisory for New Patients Patient Registration HIPPAA Patient Privacy Summary HIPPAA Acknowledgement of Privacy Notice Payment Agreement Health Insurance 2. Medicare Advisory for New Patients Patient Registration HIPPAA Patient Privacy Summary HIPPAA Acknowledgement of Privacy Notice Medicare Payment Agreement 3. MVA Advisory for New Patients Patient Registration MVA HIPPAA Acknowledgement of Privacy Notice HIPPAA Patient Privacy Summary Authorization to Release PIP Info Letter of Protection OPTIP 9-10jh 4. Private Pay Advisory for New Patients Patient Registration HIPPAA Acknowledgement of Privacy Notice HIPPAA Patient Privacy Summary Flat Fee Payment Agreement 5. Worker's Compensation Advisory for New Patients Patient Registration WC HIPPAA Acknowledgement of Privacy Notice HIPPAA Patient Privacy Summary Payment Agreement WC
1. General Conditions a. Cervical/Thoracic Pain Scale General Questionnaire Discomfort Scale Cervical-Thoracic Functional Index b. Upper Extremity Pain Scale General Questionnaire Discomfort Scale Upper Extremity Functional Index c. Lumbar Pain Scale General Questionnaire Discomfort Scale Lumbar Functional Index d. Lower Extremity Pain Scale General Questionnaire Discomfort Scale Lower Extremity Functional Index 2. Pelvic Floor a. Pelvic Pain Pelvic Pain Questionnaire Vulvar Pain Functional Questionnaire Pelvic Floor Functional Index b. Bladder Disorders Urinary Incontinence Questionnaire Pelvic Floor Functional Index c. Bowel Disorders Fecal Incontinence Questionnaire Pelvic Floor Functional Index 3. TMJ Jaw/Face Questionnaire TMJ Discomfort Scale TMJ Functional Index
a. Cervical/Thoracic Pain Scale General Questionnaire Discomfort Scale Cervical-Thoracic Functional Index b. Upper Extremity Pain Scale General Questionnaire Discomfort Scale Upper Extremity Functional Index c. Lumbar Pain Scale General Questionnaire Discomfort Scale Lumbar Functional Index d. Lower Extremity Pain Scale General Questionnaire Discomfort Scale Lower Extremity Functional Index
a. Pelvic Pain Pelvic Pain Questionnaire Vulvar Pain Functional Questionnaire Pelvic Floor Functional Index b. Bladder Disorders Urinary Incontinence Questionnaire Pelvic Floor Functional Index c. Bowel Disorders Fecal Incontinence Questionnaire Pelvic Floor Functional Index
