FORMS:

Please complete forms 1-3 and email to jeff@jeffstatept.com or bring to your appointment.

Patient Information (Form 1)

Health History (Form 2)

Privacy Practices Signature (Form 3)

Privacy Practices Information

QUESTIONNAIRES:

Please complete one of the following questionnaires and email to jeff@jeffstatept.com or bring to your appointment.

Arm, Shoulder, or Hand

Back

Lower Extremity

Neck

PLEASE NOTE:

If your insurance requires preauthorization for physical therapy or requires a referral and you do not have one, please contact our office prior to scheduling an appointment so that we can be sure everything is in place prior to your first visit. Also, please complete intake forms prior to your first visit if possible. If you are unable to do this, please arrive 15 minutes early to complete forms.