Patient Registration
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Registration forms (.pdf format, 153KB)
IMPORTANT: WHEN PRINTING THE REGISTRATION FORMS, DO NOT SELECT THE "SHRINK TO FIT" OR "FIT TO PAGE" OPTIONS: THE FORMS INCLUDE MEASUREMENT LINES WHICH MUST REMAIN ON A 10-POINT SCALE.
The link above takes you to forms for Therapeutic Associates' outpatient clinics 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 accurately bill your insurance.
We realize filling out paperwork for healthcare in today's world is no picnic. 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.
The following forms are included:
- Patient Registration
All patients must complete this form down to the dotted line. If you have had an accident, you must also complete the section below the line. Please bring your insurance card(s) to your first visit, as we will need photocopies for our records.
- Patient Initial Questionnaire
Your answers on this form will allow us to have an accurate picture of your current physical condition and is valuable for a thorough evaluation by your therapist.
- Patient Health History
This form provides us with pertinent medical information that may affect your condition and treatment.
- CareConnections Outcomes Worksheet
This form helps give your therapist an idea of your current functional level. You should complete every question under Part I. Next select and complete the appropriate body section(s) related to your medical condition. Finally, complete Acuity and Pain Index.
Adobe Acrobat Reader is required to view the registration forms. You can download a free version of Adobe's Acrobat Reader here.
Specialty Program Forms
More Information
Please contact the clinic where you have scheduled your appointment directly if you have questions. As a reminder, be sure to bring your insurance card and any co-payment that you may be required to make to the visit. We accept cash, personal checks, and bankcards.
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