REGISTRATION FORMS

 

Medford Sports Injury & Therapy Center Inc.
Registration Forms

Welcome and thank you for choosing us to be your physical therapy provider. We at Medford Sports Injury realize that filling out paperwork is time consuming. However, we need to have these forms filled out and returned to us before you see your physical therapist.

We have made every effort to minimize the paperwork required for our patients, while also getting the information we need to provide you with the highest quality service possible.

In order to make better use of your time at our clinic, we have provided you with registration forms to be printed and completed prior to arriving at your first appointment. The forms included in this registration packet enable us to learn about your condition and how it affects your daily life, understand your overall health, track the effectiveness of your rehabilitation, and 

1) REGISTRATION FORMS (click here)
2) CHOOSE ONE: FUNCTIONAL DIAGNOSIS (See below)

In addition to the Patient Information form, please print and complete the body problem area form that best describes your issue(s) from the list below:

 
English:
Lumbar = Middle to Lower Back
Cervical = Neck to Upper Back
Upper Extremity = Shoulder Elbow Wrist Hand 
Lower Extremity = Hip Knee Ankle Foot
Other = Multiple Problem Areas 
 

Spanish:
Lumbar = Centro y abajo en la espalda
Cervical = Cuello al parte arriba de la espalda
Extremidad Super
iorHombro Codo  La Muñesa  Mano
Extremidad Inferior =  Cadera Rodilla Tobillo Pies
Otro= Problemas en varios partes 

You will receive a copy of the NOTICE OF PRIVACY PRACTICES from the front desk or you may print it here:  

English:  Notice of Privacy Practices
Spanish: Aviso Sobre Las Prácticas de privacidad 
English:  HIPPA Medical Release Form

Please complete all forms. Return them to us with your insurance card (s) and photo I.D. on or before your first visit. If you have any questions regarding the registration forms please give us a call at 779-6146, or send us an e-mail by clicking here. 

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KAREN - OFFICE MANAGER