Save time on your first visit and fill out our forms in advance. Everyone should fill out the patient registration, medical history and personal representative/medical record forms.
Health Summary Form
What it is: Patient history at-a-glance that helps our experts treat you effectively.
Tip: Include all your allergies, prescription medications, and other relevant medical information at the bottom of the form, so our team can ensure you receive the best care possible. Our therapist will review this form with you during your first appointment.
Medical History Form
What it is: A questionnaire that helps us to understand the big picture of your health.
Tip: Your response to “what medications are you currently taking?” should include prescription medications, frequently used over the counter remedies, and vitamins and supplements. If necessary, list them on a separate sheet of paper and attach to the form.
Patient Registration Form
What it is: Your basic information, the first building block of your patient file.
Tip: At the bottom of the form, patients are asked if they have Advanced Directive documents, which include your Living Will and your Medical Power of Attorney plan.
Personal Representative Form/Medical Records Request
What it is: This is a very important form. It should be completed by the patient, or guardian if the patient is under 18.
Tip: The patient contact information at the bottom of the form lets you or your personal representative tell In Motion exactly how you want to be contacted.