Patient Intake Forms & Resources
Download and complete your new patient registration forms before your first visit to save time in the reception lounge.
Downloadable Intake & Clearance Forms
Click “Preview & Print” to review any document online or download directly to your device.
New Patient Intake & Medical History Form
Required registration documentation covering health history, current symptoms, prior treatments, and emergency contacts. Completing this ahead of your visit saves 15-20 minutes.
Medical Prescription / Physician Referral Form
Standard referral form for your primary care physician, orthopedic surgeon, or treating doctor specifying physical therapy or chiropractic orders, diagnosis codes, and treatment frequency.
EMG / Nerve Conduction Referral Form
Specialized clinical referral form for electromyography (EMG) and nerve conduction diagnostic testing evaluation.
Insurance & Payment Verification Worksheet
Guidance on health insurance coverage, Medicare guidelines, auto accident injury med-pay/liens, and worker's compensation authorization.
Preparing for Your First Physical Therapy Appointment
Here is everything you need to know to ensure a smooth, comfortable initial evaluation.
What to Bring
- Valid Government Photo ID (Driver’s License)
- Current Medical Insurance Card
- Physician Referral or Prescription (if provided)
- Pertinent MRI, X-ray, or Operative Reports
Arrival & Attire
- Arrive 15 minutes early if filling out paperwork in clinic
- Wear loose, flexible athletic clothing (shorts/sweats)
- Wear supportive walking shoes or sneakers
- For aquatic therapy: pack swimsuit, towel, and clean water shoes
What to Expect
- Thorough 45–60 minute physical & chiropractic examination
- Hands-on joint range of motion & strength tests
- Clear explanation of diagnosis & personalized recovery plan
- Initial pain relief treatment or home exercise prescription
Insurance Plans & Coverage Options
We work closely with health plans and medical networks to make your rehabilitation accessible.
Medicare Part B
Accepted for all medically necessary physical therapy and chiropractic evaluations with a physician referral.
PPO Health Networks
We accept Blue Cross, Blue Shield, UnitedHealthcare, Aetna, Cigna, and other major PPO plans.
Workers' Compensation
Comprehensive care for on-the-job injuries under California MPN guidelines with physician authorization.
Auto / Personal Injury
Direct billing for motor vehicle collisions through Med-Pay coverage and qualified attorney medical liens.
Have questions regarding copays, deductibles, or whether a doctor's prescription is required?
Ready to Make a Move
Toward Better Health?
Take the next step toward better movement and improved function. Contact Active Physical Therapy & Associates today to begin your personalized recovery.