Patient Information

Please use the following forms to help with your registration at Community Rehab Physical Therapy. The information under each heading will provide you with help in selecting which form to print and bring with you to your appointment.

Patient Registration Forms
Please complete all sections as appropriate. If the patient is 18 or younger, a parent or guardian is responsible for signing the consent for treatment section.

• Patient Registration Forms

Health Information Portability and Privacy Act (HIPPA) Form
The following documents outline the HIPPA Compliance Plan of Community Rehab. The Notice of Health Information Practice Policy is information that you can review as it applies to your situation. Please print the Consent to Use and Disclose form and bring it with you.

• Consent to Use & Disclosure
• Notice of Health Information Practice (HIPPA)

Policy Patient Insurance Information Form
Please print this document and bring with you for your inital physical therapy appointment. The information applies to the patient AND the primary insured as indicated on the card.

• Insurance Information Form

Additional Forms

• Customer Survey
• Testimonial Consent Form