Elite Performance Physical Therapy P.C.
Patient Registration Forms
Download the forms that apply to you. Print them out and bring the completed forms with you to be seen more quickly by the therapist on the day of your appointment.
Forms for All Patients
REVIEW OF SYSTEMS
ACKNOWLEDGEMENT OF RECEIPT OF HIPAA
CONSENT FOR CARE / BENEFIT ASSIGNMENT / MEDICAL RECORD AUTHORIZATION
AUTHORIZATION TO PAY
Download any of the forms below if applicable
NEW YORK MOTOR VEHICLE NO-FAULT INSURANCE LAW ASSIGNMENT OF BENEFITS
AGREEMENT TO PAY IF WORKERS COMPENSATION IF CLAIM IS DENIED