physical therapy in your home

pottsville, hazleton, jim thorpe, tamaqua, lehighton, weatherly, frackville, ashland, shenandoah, hegins, valley view, tower city, orwigsburg, schuylkill haven, pine grove

Tel: 1-888-929-7677

Fax:  1-888-929-7677

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Patient Forms

In order to get you started, the following forms will help you bypass the intake process when you arrive for your first visit. Please fill these out to the best of your ability and bring them along to your appointment.


Patient Consent to Services Non-Medicare (WORD FORMAT)


Patient Consent to Services Non-Medicare (PDF)


Patient Consent to Services Medicare (WORD)


Patient Consent o Services Medicare (PDF)


Patient Privacy Policy (WORD)


Patient Privacy Policy (PDF)


Patient Intake Form (WORD)


Patient Intake Form (PDF)