Forms for your first visit

For your convenience we have provided links to the new patient paperwork required at your first visit. By printing and completing the documents linked here and bringing them with you to your first appointment you can save yourself some time in our waiting room.

Online Registration
Click on this link to complete our online registration form. It is secure, encrypted and HIPAA compliant and takes about three minutes. It will save time on the day of your visit.

All forms
Please download this package and fill out all the forms it contains.

Patient Registration
This form asks for basic information, so we can register you as a patient.

Informed Consent for Physical Therapy Services
This form acquaints you with our policies and procedures and includes an authorization to release information to your insurance company, and an agreement to pay for services rendered.

Privacy Practices Acknowledgement
Your signature on this form acknowledges you have read and understood the policies and practices described in the Notice of patient information practices.

Notice of Privacy Practices
This notice describes how medical information about you may be used or disclosed and how you can access that information.

Schedule an Appointment Visit our locations
Physical Therapy San Jose  • Physical Therapy Cupertino  • Physical Therapy Sunnyvale  • Physical Therapy Saratoga  • Physical Therapy Santa Clara
20823 Stevens Creek Blvd #200 | Cupertino, CA 95014 | (408) 252-6076
20730 Valley Green Drive | Cupertino, CA 95014 | (408) 252-6076
595 Park Ave #101 | San Jose, CA 95110 | (408) 947-8466