Evergreen Sport & Spine Physical Therapy

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Kimberly Kaiser

Kim Aseltine

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Physical Therapy with the Right Attitude!

Patient Registration Forms


Please print the four forms below. Complete the forms and bring them with you to your first appointment along with your insurance card(s), referral or therapy prescriptions, doctor's notes & any radiological imaging pertaining to your current injury.

Bring comfortable clothing, athletic or sensible shoes to each appointment. This will make your evaluation and treatments sessions easier and more productive.

Co-payments are taken prior to your visit. Cash, Check, Visa & Mastercard are accepted forms of payment.


Document
New Patient Registration Form
Document
Financial Policies/Treatment Authorization
Document
Patient Medical History
Document
Functional Activity Questionaire

You must have Adobe Acrobat Reader® 5.0 or greater to view and print these PDF files below. If you do not currently have this software, download it for free at www.adobe.com, or click on the Adobe Acrobat logo below.

 


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