Download Medical Forms
Welcome! The following is a guide and explanation for the forms you will need to bring on your first visit to Seabreeze Physical Therapy.
- Form #1 Patient Information . This form is for your personal information (i.e. address, telephone number, insurance information)
- Form #2 Medical History. This form represents your past medical history for your therapist. In this form it is very important to fill out each section.
- Form #3 Consent to Treat/Privacy Practices This form gives Seabreeze Physical Therapy and it’s employee’s permission to treat you for the condition diagnosed and prescribed by your physician.
- Form #4 Insurance Protocol This form explains Seabreeze Physical Therapy’s billing procedures and gives us permission to bill your insurance and receive payment for services on your behalf.
Along with the four forms please bring your prescription from your physician for physical therapy along with your insurance cards and picture identification.
If you have any questions please feel free to contact us by using the “contact us” tab on this website or by calling (727) 384-4600.
Our staff will be happy to assist you with this paperwork.
You can either fill out these forms online or download them at the link below and print them to bring with you your first appointment.
New Patient Intake Forms (212.2 KB)