Get Lor Physical Therapy Intake Form

Completing the LOR Physical Therapy Intake Form online is a straightforward process that gathers essential information to support your therapy journey. This guide will provide you with clear instructions for each section of the form, ensuring you fill it out correctly and efficiently.

Follow the steps to complete the intake form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin with your personal information. Fill in your last name, first name, and date of birth in the designated fields. This information is vital for identifying your record.
3. Provide your home address and, if different, your billing address. Ensure accuracy in your contact details, as notifications regarding appointments and waitlist openings will be sent here.
4. Enter your primary and optional secondary phone numbers, as well as your email address. This will facilitate future communication and appointment reminders.
5. If the patient is a minor, fill out the emergency contact information with the name, relationship, and contact details of the guardian.
6. Indicate if you will use insurance for physical therapy sessions. Provide details about your primary and secondary insurance carriers, including ID and group numbers.
7. Select the referral source from which you heard about the clinic. This helps the clinic understand how patients find their services.
8. Complete the medical history section by checking off any past or current conditions. Be honest as this information is crucial for tailored care.
9. Fill in information regarding any surgeries, current medications, and recent health changes to give your therapist a complete picture of your health.
10. Fill out the Neck Disability Index to assess your pain levels and how they affect daily activities. Mark the checkbox that corresponds to your experience.
11. Review the payment policy and acknowledge receipt of the financial responsibility and privacy policies. Your signature confirms understanding and agreement.
12. Once all fields are complete, save your changes and review the form for accuracy. You can then download, print, or share the form as needed.

Start completing your LOR Physical Therapy Intake Form online today for a smoother entry into your therapy journey.