New Patient Forms

Welcome Letter

We want to offer you a warm welcome to our clinic and than you for choosing our facility. Your rehabilitation team will consist of Dr. Mary Stout, Doctor of Physical Therapy; Dr. Steven Jeffreys, Doctor of Physical Therapy; Becky Wetzel, Licensed Physical Therapist Assistant; Jane Carroll, Certified Massage Therapist; and Nathan Polan, Technician.

We strive to provide the utmost excellence in physical therapy care and to achieve great results with all of our patients. All you have to do is show up!

We want you to keep us informed of your progress and in order to facilitate this, we will request that you complete a “Success Story Form” and “How Did We Do?” Questionnaire Form. These forms are used to let us know, not only when it is going great for you, but also to indicate if there are any things that you feel we could do better.

In order for us to bill your insurance company, please provide the billing office with all insurance plans complete with name, policy/group or claim number, address, phone, and agent/representative, if applicable. All co-pays are expected to be paid at every visit. If you request a copy of your medical records there is a $35.00 fee. Our staff includes Lori Maurer, Billing Specialist.

Our staff is friendly and very willing to provide for all your needs so please let us hear from you as often as possible.

Thank you and once again, WELCOME!

Download New Patient Forms