Therapist assisting client

Printable Forms

The forms available through this page can be downloaded, filled-out (manually or type in the actual pdf file), and printed, giving you the ability to fill out the necessary paperwork before you visit our office. This will speed up your visit and help us treat you quicker. Our forms are available in the Adobe PDF format.

ALL NEW PATIENTS: PLEASE FILL OUT AND PRINT the "NEW PATIENT PACKET". There are EIGHT (8) pages within this downloadable file. ALL must be filled out completely. Please also read the HIPAA compliance policy under "patient privacy" in the PATIENT INFORMATION drop down menu before signing "Acknowledgement of Receipt of Notice of Privacy Practices" (one of the forms within form "NEW PATIENT PACKET").

If your are coming to Made to Move without a doctor's referral/prescription (Direct Access), then, in addition to the new patient paperwork, you must also read and sign the DIRECT ACCESS DISCLOSURE form. If you are a returning patient to the clinic, please fill out the RETURNING PATIENT PACKET only.

If the patient is a minor, the authorization to treat a minor, in the NEW PATIENT PACKET, must also be filled out. Complete the BACK QUESTIONNAIRE for patients who are being treated for a back problem and/or sciatica, and NECK QUESTIONNAIRE for those patients who are being treated for a neck problem.

After you have completed your treatment at Made to Move Physical Therapy, Inc., please feel free to fill out the DISCHARGE SURVEY. We always appreciate customer feedback and want to know how we are doing to satisfy your needs as a client. Please mail back to:

Made to Move Physical Therapy, Inc.
615 N Nash St., Suite # 306
El Segundo, CA 90245

© Copyright 2008. Made To Move. All Rights Reserved.