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Preparing For Your Visit

Please arrive 10 minutes early for your initial visit wearing loose, comfortable clothing and plan on bringing the following:

• Doctor Referral Script
• Insurance Card along with another form of ID (i.e. Driver's Licenses)
• Completed Appropriate Forms (See Below)
• Your calendar, so we can plan your next visit!

Patient Intake Forms:
Please download, print, and fill out the appropriate forms prior to your first appointment. Call 512-329-6617 with any questions regarding physical therapy intake forms, and call 512-428-4261 with any questions regarding Women's Health and Pelvic Health intake forms.

Physical Therapy Patients:
New Patient Intake Forms

Womens Health Patients:
Vulvar Vaginal Pain Evaluation Forms
Urinary Incontinence Prolapse Evaluation Forms
Trunk Pelvis OB Evaluation Forms
Pelvic Floor Consent To Treat
Bladder Record

Pelvic Health Patients:
Bowel Dysfunction Evaluation
Male Pelvic Floor Evaluation

Additional Forms Per Insurances:
Medicare Patients:
ABN Form (Click here for a description of ABN (Advanced Beneficiary Form)

United Patients:

Patient Summary Form (All United Patients)

Also choose appropriate forms with related body part...
Arm, Shoulder, Hand Disabilities
Back Index
Lower Extremity Functional Scale
Neck Index

United Health Insurance requires the above forms in order to approve authorization for physical therapy. These forms must be completed prior to your first appointment.