PATIENT FORMS

The links below will allow you to download forms required for your first physical therapy visit.  It will be helpful to print and complete prior to your first session.  However, if you are unable to download these forms, they are available at the clinic.

In addition to these forms, please bring your prescription from your physician for physical therapy along with your insurance cards and photo ID.  It is helpful to wear comfortable clothing.

Healthy Image Physical Therpy's  Protected Health Information Privacy Policy Information Form / HIPPA is located in a 3 ring binder in the clinics waiting room
for your information or you may request a personal copy at any time. You may download this form by clicking on the Notice of Pricacy icon.


Patient Information Page 1


Patient Information Page 2





                              * Adobe Acrobat Reader Required-  Click Here




If you have any questions, please feel free to contact us by calling 727-584-0053 or contact us at info@healthyimagept.com