Lotus Physical Therapy - ...restoring health and improving performance...
Downloadable PDF forms
 
Prior to your initial appointment please print and fill the following forms out:
 
***if you do not have Adobe Acrobat Reader, follow this link to get your free copy. 
 
medical history hipaa
  1. Physical Therapy Prescription (have your doctor fill this one out)
  2. Admission Package (Consent/Demographics/Insurance/medical history, etc)
  3. Notice of Privacy Practices (HIPAA/government requirement)
  4. Authorization to Disclose PHI (if you need us to send any part of your medical record to third party, etc.)
  5. Patient Summary Form   (only required for United HealthCare)
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