In Motion Patient Forms
Save time on your first visit and fill out forms in advance. Everyone should fill out the outpatient registration, medical history and personal representative forms.
Contact us today to make an appointment or visit our locations in Hampton Roads.
• Carrollton – Eagle Harbor Medical Associates
• Victory YMCA
• Mary Immaculate Hospital
• Denbigh Physical Therapy & OccuMed
• In Motion Physical Therapy-Norfolk
• Maryview Outpatient Physical Therapy
• Portsmouth YMCA Churchland
• Health Center at Harbour View
• Health Center at Virginia Beach
• In Motion Physical Therapy-Hilltop
• Portsmouth Blvd. Physical Therapy & OccuMed
• Boo Williams Sportsplex
Physical Therapy Outpatient Registration form
what it is: Your basic information, the first building block of your patient file.
tip: At the bottom of the form, patients are asked if they have Advanced Directive documents. That’s how a Living Will and a Medical Power of Attorney are called. If you don’t have an Advanced Directive prepared, you can download that form from this page, too.
Physical Therapy Medical History Form
what it is: A questionnaire that helps us to understand the big picture of your health.
tip: Your response to “what medications are you currently taking?” should include prescription medications, frequently used over the counter remedies, and vitamins and supplements. If necessary, list them on a separate sheet of paper and attach to the form.
Personal Representative Form
what it is: This is a very important form. It should be completed by the patient, or guardian (if the patient is under 18.)
tip: The Patient Contact information at the bottom of the form lets you or your personal representative tell In Motion exactly how you want to be contacted.