Physical Therapy and Sports Medicine Centers
 
PT For Life
 
 

Intake Forms

As with most healthcare practices there are forms that need to be completed prior to your initial examination.  For your convenience and to save time, we have listed our new patient forms below for you to print and complete, prior to your first visit.

The Medical History form assists our clinical staff in their evaluation of how to proceed with treatments of your injury.  Know that your Medical History form is confidential between you and your therapist.

For purposes of HIPAA, please read our Notice of Privacy Practices, as it describes how we may use and disclose your protected health information to carry out treatment, payment or health care operations.

By signing the Consent Form you are giving PTSMC permission to:

  1. You agree and give consent for Physical Therapy and Sports Medicine Centers to provide necessary medical care and treatment.
  2. Authorizing us to release any information needed for the payment of any claim to your insurance carrier, and payments to Physical Therapy and Sports Medicine Centers from your insurance carrier or third party payer.
  3. Use and disclose your protected health information to carry out treatment, payment activities and health care operations.

Your First Visit
Appropriate clothing is necessary for you to get the most out of your physical therapy sessions.  Please wear comfortable, loose fitting clothing that you can exercise in.  This includes sweatpants, t-shirts, or shorts.  For patients who are coming to physical therapy before or after work, we have changing rooms available.

Medical History Form

HIPAA Notice of Privacy Practices

Consent Form

Directions

Your First Visit

 



We improve the quality of people's lives by providing:

  • unmatched experiences
  • clinical excellence
  • lifelong relationships

11 Connecticut Locations