Pacific Coast Physical Therapy - ...restore health and improve performance...
admission formsDownloadable PDF forms   

Prior to your initial appointment please print and fill in the following forms:  
  ***if you do not have Adobe Acrobat Reader, follow this link to get your free copy.     

 
  1. Physical Therapy Prescription (have your doctor fill this one out)
  2. Admission Package (Consent/Demographics/Insurance/medical history, etc)
  3. Notice of Privacy Practices (HIPAA/government requirement)
  4. Authorization to Disclose PHI (if you need us to disclose any part of your medical record to a third party, etc.)
  5. Patient Summary Form  PSF-750 (only required for United HealthCare)


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