Accessible Physical Therapy Patient Registration and Workers Compensation Form

All patients need to complete the following forms:

• Assignment of Benefits A&A
• Consent and No Show
• Consent To Release Medical Records
• HIPPA Notice of Privacy Practice
• Patient Information Form
• Patient Information Update Form

Patients treating for auto and/ or work related injuries also need to complete the following form:

• Page 3 Form

Please fill out and print these forms and bring it with you on your first visit at Accessible Physical Therapy Clinic.
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