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By clicking on the bars below left, you can download Adobe PDF versions of the Patient Intake Forms that you will be asked to fill out as a new patient at the Human Performance Center.
Click on the correct category below left and when the window opens up, click the black Download Forms> button
We hope this will be more convenient and private for you. Please bring them with you to your first appointment. Thanks!
> Regular Private Insurance
> Worker's Compensation
> HMO
> Fit Start
>Medicare
Includes: Basic Patient Registration Form; Brief Patient History; Privacy and Security Notice; PPO Financial
(5 pages total)
(5 pages total)
Includes: Basic Patient Registration Form; Brief Patient History; Privacy and Security Notice; Workers Comp Agreement
(5 pages total)
(5 pages total)
Includes: Basic Patient Registration Form; Brief Patient History; Privacy and Security Notice; HMO Financial
(5 pages total)
(5 pages total)
Please download this 11-page form and take your time filling it out before bringing it with you to your first visit. (11 pages total) To get started, call us at 687-8553 and ask about FitStart.
Includes: Basic Patient Registration Form; Brief Patient History; Privacy and Security Notice; Medicare Financial; Medicare Cap
(6 pages total)
(6 pages total)