Patient Forms

Can’t complete them online? Printable forms

Only if you are unable to complete the forms digitally, you can print these instead, fill them in at home, and bring them with you.

• Patient Intake Form. Every new patient needs this one. Ask your clinic to email you a printable copy.
• Pelvic Health Form. Only if you are coming in for pelvic floor therapy.
• HIPAA Notice of Privacy Practices. Nothing to fill in. Ask the front desk for a copy to read and keep.

Printable forms are PDF files. If they will not open on your computer, install the free Adobe Acrobat Reader and try again.

Arrive as early as your clinic told you to. That window is what lets the front desk and your therapist be ready the moment you walk in.

If you cannot use the portal or print the forms

Nothing goes wrong. Come in early and fill them in at the front desk instead. There are clipboards and pens and someone who will help if a question is unclear.

You can also ask us to send them to you. Email your clinic: mesa@moorephysicaltherapy.com, tempe@moorephysicaltherapy.com, or gc@moorephysicaltherapy.com.

What to bring to your first visit

• Your forms completed in the patient portal, or printed and filled in, or the extra minutes to do them at the desk.
• A photo ID and your insurance card.
• Your prescription or referral, if a doctor gave you one. Self-pay patients do not need one; patients using insurance do. The insurance page covers that.
• A list of the medications you take.
• Clothes you can move in and shoes you can walk in. For a knee, a hip or an ankle, shorts make the evaluation easier.
• Your questions. Write them down before you come, because people forget them in the room.

You walk out of that first visit knowing what is wrong, how long it takes, and what happens next.

Your privacy

Your health information is handled under HIPAA: secure storage, restricted access, and regular staff training on privacy practices.

The Notice of Privacy Practices above spells it out in full. If anything in it is unclear, ask us at the desk or on the phone. It is a fair question and we would rather answer it than have you wonder.