Medical HistoryTo help save time at your visit to Peak Physical Therapy, P.C.we suggest that you print out the applicable forms from the list below and bring the completed form with you.
You need Acrobat Reader to open these forms. Click here for a free download.
Please fill out the following forms for ALL patients:
Please fill out the following according to the body part/parts being treated:
If you have The Empire Plan or Oxford insurance plese fill out the following according to the body part/parts being treated:
If your injury was a result of a car accident please fill out the the following additional form:
If your therapy is covered under Medicare please fill out the following form as well.