Free Screening

Forms & New Patient Information

Complete your paperwork ahead of time so your first visit is spent on care, not clipboards.

Patient forms

Printable forms are being prepared. In the meantime, call the clinic and we will email or mail them to you.
New Patient Intake Form

Personal, insurance, and medical history details for your first visit.

Request Form
Medical History Questionnaire

Past conditions, surgeries, and current medications.

Request Form
Consent to Treat

Standard consent for physical therapy evaluation and treatment.

Request Form
HIPAA Privacy Notice

How we protect and use your health information.

Request Form
Insurance Authorization

Permission to bill your insurance plan on your behalf.

Request Form
Home Exercise Log

Track your home program between visits.

Request Form

What to bring to your first visit

  • Photo ID and your insurance card
  • Any physician referral, prescription, or imaging reports
  • A list of current medications
  • Comfortable clothing you can move in
  • Arrive 10 minutes early to complete paperwork
Helpful links
Ready to feel better in your body?
Request an appointment or a free screening today. We are conveniently located in downtown Chicago with flexible scheduling.
Request Free Screening
(630) 474-2759