Patient Information

New Patient Checklist

Patient Check List for Initial Evaluation:

Doctor’s Prescription, MRI/X-Ray Reports, etc
Patient’s ID (driver’s license, etc)
Patient’s Insurance Card

Dress Comfortably:

Lower Extremity Patients: Shorts or loose pants
Upper Extremity Patients: T-Shirt or loose shirt
*Lockers are provided by JAG Physical Therapy

Forms for the Patient to have on their Initial Evaluation:

Patient Information Form
Consent Signature Form
Medical History Forms

Documents

Patient Authorization Form

Patient Health Questionnaire

Workers Compensation Form

Private Insurance Form

Lower Extremity Functional Scale

Arm, Shoulder and Hand Functional Scale