Patient Forms

Each patient planning to schedule an appointment at BSR Physical Therapy should complete the following forms to the best of their ability prior to arriving for their initial visit. Please call us if you have any questions.

1. Medical Screening Form
2. Notice of Privacy Practices
3. Medicare Secondary Payer Form

Please complete only ONE of the following forms corresponding to the area(s) related to your problem:

• Low back
• Neck or upper back
• Shoulder
• Elbow, wrist, or hand
• Lower body (including balance difficulties), hip, thigh, or knee
• Foot or ankle