To
stream-line your registration, we offer our forms online so you
can print the forms and fill them out prior to your first scheduled
appointment. All forms below are required by all clients
being treated at Black Diamond Physical Therapy.
You
may also right-click the form name and select "Save Target As"
to save the form onto your computer to fill out later (except
the Insurance Verification). You must have Adobe
Acrobat Reader Version 9 in order to use the fillable forms.
Insurance
Verification
- Fill out this online form on your computer and click "Submit".
If you have already provided this information over the phone,
you do not need to complete this form.
Client
Medical History
- Fill out this form completely on your computer, print it out,
and sign at the bottom.
HIPAA
Privacy Policy - Review this form and proceed to
Authorization. Keep the HIPAA Privacy Policy for your personal
records.
Authorization
- After reviewing the HIPAA Privacy Policy, fill out this form
and sign as indicated.
Photo/Video
Release Waiver - We often use photo and video analysis
during evaluation. Sometimes, we use these images for educational
or marketing purposes. If you would rather not allow us to use
your images, do not fill this out.
Make
sure to bring these completed forms, your prescription, your insurance
card, and a government issued ID to your first appointment.
Be sure to bring comfortable clothing. If you have any questions,
contact us.
