At Mountain Physical Therapy our goal is to work with you to restore function, alleviate symptoms, teach you self-management techniques, and prevent future occurrences.
Please print, fill out, and bring the following forms with you to your first appointment.
- New patients
Patient Registration (download pdf)
Patient Medical History (download pdf)
Patient Medication List (download pdf)
Notice of Patient Information Practices (download pdf)
- Returning patients
Patient Registration (download pdf)
Patient Medical History (download pdf)
Patient Medication List (download pdf)
Notice of Patient Information Practices (download pdf)
If you are having a problem in one of the areas listed below, please also print and fill out no sooner than 24 hours before your first appointment.
Please bring the form with you to your first appointment.
- Neck problem
Neck Disability Index (download pdf)
- Back problem
Modified Oswestry Low Back Pain Questionnaire (download pdf)
- Shoulder/arm problem
Quickdash (download pdf)
- Hip/knee/foot problem
LOWER EXTREMITY FUNCTIONAL SCALE (download pdf)
For information regarding insurance coverage,
please click here or contact our office for
further information at (828) 254.3525.