New Patient Forms
Thank you for choosing BreakThrough! We look forward to working with you. For your convenience, we’re providing our patient forms below. To help expedite your first visit, please download, print and complete the applicable forms and bring them with you for your first visit. If you choose to fill out the packet in office, please arrive 30 minutes early to allow enough time to complete the forms before your scheduled appointment time.
General Physical Therapy Forms
- BreakThrough Physical Therapy Patient Information Form
- BreakThrough Physical Therapy Medical History Form
- BreakThrough Physical Therapy HIPAA Consent Form
- BreakThrough Physical Therapy Patient Communication Preferences
- BreakThrough Physical Therapy General Photo/Video Release Form
Pediatric Forms
- BreakThrough Physical Therapy Pediatric Patient Form
- BreakThrough Physical Therapy Pediatric HIPPA Consent Form
Pelvic Health Questionnaire
Formas en Espanol
- BreakThrough Physical Therapy Pelvic Health Questionnaire (en Español)
- BreakThrough Physical Therapy Medical History Form (en Español)
- BreakThrough Physical Therapy HIPAA Consent Form (en Español)
- Notice of Privacy Practices (en Español)