new patient paperwork

Patient Treatment Referral

PLEASE NOTE: Alabama has direct access for physical therapy as of June 1, 2024. This means that you can come see us for an injury, prevention of injury, or performance enhancement without having to see someone else first.

However, some insurances require a referral regardless. A referral for treatment can also come from an MD, DO, Physician’s Assistant (PA), Nurse Practitioner (NP), Dentist, Podiatrist, or Chiropractor licensed anywhere in the United States.

You can bring the referral with you or have him/her fax it to 256-513-9952.

**Wellness services do not require a referral**

Patient Referral Form

New Patient Packets

Please download the Intake Forms along with only one survey specific to your problem. Download the PDF files, print, and fill out all forms prior to your first appointment. If you have any questions, please call our office at 256-203-3804.

Patient Intake Forms

Shoulder, Elbow, Hand

Hip, Knee, Ankle, Foot

Neck

Back

TMJ

Headache only

Global Pain

Dizziness

Medical Record Release Authorization

If you feel that you have medical records you would like me to review and consider while creating your plan of care, please download, print, and fill out the first page. Bring both pages with you to your evaluation. You may also email, fax, or snail mail them to me prior to your evaluation, so I can go ahead and fax them to your other medical provider.

Medical Record Release Authorization

Patient Privacy Notice

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