New Patient Information
Please arrive 15 minutes early to your first appointment to ensure completion of all necessary paperwork. For your convenience and to expedite your check in process, please download the following forms (HIPPA, Patient information, and Functional Outcome Measure) and bring them completed with you to your first appointment.
• HIPPA (Download as PDF) (Download as DOC)
• Patient Information (Download as PDF) (Download as DOC)
• Functional Outcome Measure: (Download as PDF) (Spanish Version - Download a PDF)
* Additional forms to fill out if your primary insurance is Regence: (Download as PDF)
* Additional forms to fill if your insurance is Premera: (Download as PDF)
Checklist for your first appointment
Please bring:
☑ Your referring provider’s written prescription, referral or pre-authorization (Referrals must be issued within the past 30
days)
☑ Completed downloaded forms (see above)
☑ Appropriate clothing (see below)
☑ Your current insurance card(s)
☑ Photo Identification
☑ A method of payment for co-pays
Fragrance Policy
Due to the rising incidence of upper respiratory conditions, asthma and migraines we have implemented a fragrance policy. We ask that you please refrain from applying colognes, perfumes or scented lotions on days that you have a physical therapy appointment as the use of these products may create health problems for your therapist or other patients.
Clothing
Please bring shorts and a t-shirt with you if you have a lower back or lower extremity problem. Females with a low back, neck, upper back or upper extremity problem may bring a sports bra, halter top, bathing suit top or choose to use a provided gown. If your referral is specifically for aquatic therapy, please bring a swimsuit so we can get you started in the pool.
• HIPPA (Download as PDF) (Download as DOC)
• Patient Information (Download as PDF) (Download as DOC)
• Functional Outcome Measure: (Download as PDF) (Spanish Version - Download a PDF)
* Additional forms to fill out if your primary insurance is Regence: (Download as PDF)
* Additional forms to fill if your insurance is Premera: (Download as PDF)
Checklist for your first appointment
Please bring:
☑ Your referring provider’s written prescription, referral or pre-authorization (Referrals must be issued within the past 30
days)
☑ Completed downloaded forms (see above)
☑ Appropriate clothing (see below)
☑ Your current insurance card(s)
☑ Photo Identification
☑ A method of payment for co-pays
Fragrance Policy
Due to the rising incidence of upper respiratory conditions, asthma and migraines we have implemented a fragrance policy. We ask that you please refrain from applying colognes, perfumes or scented lotions on days that you have a physical therapy appointment as the use of these products may create health problems for your therapist or other patients.
Clothing
Please bring shorts and a t-shirt with you if you have a lower back or lower extremity problem. Females with a low back, neck, upper back or upper extremity problem may bring a sports bra, halter top, bathing suit top or choose to use a provided gown. If your referral is specifically for aquatic therapy, please bring a swimsuit so we can get you started in the pool.
