The following forms can be viewed with Adobe Reader.


New Patients using Insurance or Workers' Compensation

In order to expedite your first visit with us, feel free to view and fill out the following forms prior to your visit.
(Just make sure you remember to bring them in with you!)
If you have any questions, call Melissa at 876-6000 or email melissa.hussey@rehabgym.com

In addition to these forms, please remember to bring the following:
  • Your insurance card
  • Comfortable clothing for exercise and to allow for easy access to affected area(s)
  • Clean shoes (to be mindful that some people perform exercises on the floor)

Please READ this before filling out the new patient forms
Uses and Disclosures of Health Information

Please PRINT the following forms to fill out and bring in for your first visit
New Patient Information Sheet
New Patient Agreement
New Patient Health Questionnaire
New Patient Treatment Outcome Form




New clients coming in for a consult (not using insurance)

In order to expedite your first visit with us, feel free to view and fill out the following forms prior to your visit.
(Just make sure you remember to bring them in with you!)

In addition to these forms, please remember to bring the following:
  • Comfortable clothing for exercise and to allow for easy access to affected area(s)
  • Clean shoes (to be mindful that some people perform exercises on the floor)

Please PRINT the following forms to fill out and bring in for your first visit
Consult Health History Form
Consult Informed Consent Form




Handouts