Pioneer Sports Medicine and Physical Therapy

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Paving the path for rehabilitation excellence.

Pioneer Sports Medicine and Physical Therapy is pleased to be able to offer our patients the convenience of filling out the proper paperwork prior to their first visit to our clinics. 

Besides the proper paperwork for your initial visit, we will require:
* A current Driver's License
* A current Insurance Card
* A Physcian's Referral for Physical Therapy

The forms below are required for your first visit to our clinic.  They are in PDF format for your convenience. 

Document
Patient Intake Form
Document
HIPPA Privacy Act - Signature/Date Required
Document
Patient Questionnaire - General Information on Injury

There are four forms below that correlate to the main body part that you are dealing with an injury.  Please download the proper form that correlates to your injured area and fill out the required information.  This information allows us to have objective data on your injury.

Bring to our clinic on your first visit.  Thanks.

Document
Neck
Document
Back
Document
Shoulder, Elbow, Arm, Hand
Document
Hip, Knee, Ankle, Foot
   

Pioneer Sports Medicine and Physical Therapy © 2006
Update 03/01/2008

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