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Patient info/forms

Patient Forms

At Breeze Physical Therapy and Wellness, we want to maximize your time with us. Prior to your first visit, please click each of the links below, fill out the form online, print, sign and bring with you to your first appointment. With the exception of your signature all of the information on these forms can be filled out from your computer. Just do not forget to print once filled out so we can have your signature in ink.

  1. Consent to treat form

  2. Patient information form

  3. Past medical history form

  4. HIPPA Privacy/Practice form

  5. Office Policies form


Before Your First Visit

  • Make a list of questions you have to discuss on your first visit.

  • Please call our office to verify your insurance benefits.

  • Arrive 15 minutes early to your first appointment.

  • Bring with you a copy of your insurance card and a photo ID.


What to Expect on Your First Visit

  • You will register in the office at which point any insurance/self payment questions will be answered

  • You will will met with your Physical Therapist for your initial evaluation.

  • During the evaluation, your therapist will ask questions about your medical history, current pain, or injury. Open communication helps him to understand your current condition.

  • Your movement, strength, coordination, and much more will be evaluated.

  • Your therapist will recommend and prepare a course of treatment to ensure the quickest recovery and the best results. The recommendations and plan of care will be discussed with you.

  • There will be some treatments performed the first day to get you started on your road to recovery. However during the next visit, you will get into the full swing of your treatment plan.

  • After your evaluation you will schedule your series of visits. The amount of therapy needed with you will be discussed with your Physical Therapist.

  • Your therapist will write up their findings and treatment plant to submit them to your referring physician.

  • If you have any questions at any time, please don’t hesitate to call. We want to ensure your satisfaction and full recovery.