Forms

New Patients:

Please print and complete the following forms and bring them with you to your initial appointment. If the patient is under the age of 18, a parent or guardian must complete the Minor Consent Form. If you would like us to check your insurance benefits before your initial appointment please call our office. Please be sure to bring your insurance card with you so we can make a copy for our records.

Personal Training Clients:

Please print and complete the following forms and bring them with you to your initial training appointment. All paperwork must be completed before starting a training session.

Par Med X Form: Please complete ONLY if you answered yes to one or more of the questions on the Par-Q Form. If you answered no to all questions on the Par-Q Form you do not need to fill out the Par Med X.

New Patient Forms

New Patient Intake Form Basic background health information 3 pages - 136Kb
HIPPA Form Consent for use and disclosure of health information 1 page - 53Kb
Payment Policy Includes payment and insurance related information 2 pages - 47Kb

Other Patient Forms

Minor Authorization 1 page - 40Kb
Car Accident History 2 pages - 41Kb
Records Release 1 page - 26Kb
Work Related Accident History 3 page - 27Kb

Personal Training Forms

Physical Activity Readiness Questionnaire Physical Activity Readiness Questionnaire 1 page - 622Kb
PARmed-X Physical activity readiness medical examination 4 pages - 3.5Mb
Liability Waiver Basic waiver 1 page - 561Kb