Please print out each of these links. Fill out the information as completely as you can and bring it with you on your first appointment. This will save you 15-30 minutes of time. Below you will find a description of each of these forms to answer any questions you may have.
The above links are all of the necessary paper work for your admission to Geril Therapy-Physical Therapy/Health and Wellness.
The HIPPA PRIVACY PRACTICES- This form is yours to keep, notifying you of our practices to keep your information private.
Past Medical History Form- Please fill out the entire, form and check the appropriate box, even if it is a No. Finally sign and date.
Release of Medical Records- This will allow us to communicate, send, and receive information with you referring physician and any other physician that you deem appropriate.
Consent to Treat- This form allows us to treat you as well as documents your acknowledgement of our Privacy Practices.
Patient information sheet- Please fill out this form as completely as you can.
Medicare Secondary Form- This form is mandatory by Medicare to determine if Medicare will be your primary insurance. Please fill out completely.
Hours of
Operation: Monday–Friday, 8 a.m.–5 p.m. Weekends by Appointment
