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New Patient Forms

All new patients must have a physician referral before beginning treatment at one of our Rehab Centers.  Your physician must complete the form attached below and deliver it by mail or by fax to the appropriate Rehab Center before your first appointment.

PM&R Prescription Pad


New patients will also be asked to complete a medical history before beginning treatment.  The form is attached below if you would prefer to print it, fill it out, and bring it with you to your first appointment.  If you do not bring your own copy of this form, one will be provided upon your arrival at the Rehab Center.

New Patient Medical History


Once you become a patient, you will receive a hard copy of our outpatient handbook.  However, if you would like to learn more about your treatment and the facilities before your first visit, we would like to give you the option to view it online as well.

PM&R Outpatient Handbook