Prior to you first visit please read the following information regarding HIPAA and ACPT’s financial policy:

• HIPAA Form
• Financial Policy

Please find a list of forms below to download and fill out prior to your first visit with AC Physical Therapy:

• Intake Information
• Past Medical History
• HIPAA & Financial Policy Confirmation (See HIPAA Form and Financial Policy above)
• Consent for Physical Therapy
• Consent for Pelvic Floor Treatment (for pelvic pain and incontinence patients only)
  

For patients requiring treatment for issues relating to the forms below, please download and fill out these forms as well:

• Middle and Low Back- Back Index
• Neck – Neck Index
• Shoulder, Elbow, Wrist or Hand – DASH Form
• Hip, Knee, Ankle, or Foot – LEFS Form

Note: Some insurance companies require extra paperwork which is specific to certain policies. If you have one of these policies you will be asked to fill out 1-2 more forms prior to your first visit.