Forms
Patient Information Forms
Forms in this section are for your first visit or when you need a re-assessment.
PATIENT INFORMATION SHEET
PATIENT HISTORY
INTAKE PAPERWORK
FUNCTIONAL SKILLS
Assessments
Forms relating to assessing your current physical condition are located in this section.
NECK DISABILITY FORM
Insurance
Forms relating to your insurance coverage are located in this section.
ASSIGNMENT OF INSURANCE
Privacy Statement
Forms relating to the Lee Miller Rehabilitation Privacy Policy are located in this section.
NOTICE OF PRIVACY PRACTICES
Request An Appointment
Specialized Care for Your
Physical Therapy Needs
At Lee Miller Rehab, we are your strongest proponents for
rehabilitation. We believe that being well-informed about your
specific health situation is the first step in your recovery. We will
educate you on the specific aspects of physical therapy that will
provide you with the best outcome. We will work closely with you
and monitor your progress, making adjustments along the way
that will speed your healing.
If you have any questions or are would like to request an
appointment, please fill out the form, and a member of our team
will follow up with you ASAP.