Thank you for choosing Peak Rehabilitation & Performance Center as your provider of quality physical therapy, athletic training, and sports medicine.
Below you will find a checklist of information we will need from you prior to your first visit with us. Forms are available for download in PDF format; to download Adobe Acrobat Reader or for help with reading the PDF document, please click here.
1) Prescription from your referring physician – describing diagnosis and frequency of visits
2) Insurance Information
In order to verify and file your insurance we will need a copy of the front and back of your primary and secondary insurance cards, as well as a copy of a picture ID.
Please check with your insurance company to see if they require preauthorization.
4) Peak Rehabilitation & Performance Center’s Intake
5) Peak Rehabilitation & Performance Center’s Medical History
7) Peak Rehabilitation & Performance Center’s Financial Agreement
Back Index Functional Scale
Lower Extremity Functional Scale
Neck Index Functional Scale
Patient Registration Form
Statement Regarding Insurance Payments
Upper Extremity Functional Scale
Patient Financial Responsibility