Patient Forms

Please download and complete the applicable patient form packet prior to your initial evaluation At your first visit, you will need the following information: completed patient forms, picture identification, insurance card (if applicable), and physical therapy referral/prescription.

Physical Therapy Referral/Prescription

If your doctor hasn't already done so, please have him/her download and complete this physical therapy referral/prescription form:
This form can be given to you to bring to us or faxed to our office at (815) 477-8005.
If you are unfamiliar with our clinic or have never received physical therapy, do not hesitate to view the New Patient Video or read through the provided material in the Frequently Asked Questions (FAQ) portion of the website.
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