In Motion Patient Forms
After an injury, surgery or illness, “picking yourself up” can be more than a figure of speech. Once a physician has determined the damage, the focus quickly turns to putting you on the path to recovery of lost skills. That’s where physical therapy comes in.
Contact us today to make an appointment or visit our locations in Hampton Roads.
• Boo Williams - 757.224.4601
• Harbour View - 757.673.5971
• Hilltop - 757.437.0471
• Virginia Beach - 757.463.2540
• Yorktown Victory Y - 757.952.1900
Give the Gift of Sport
Visit our locations in Hampton Roads. See our range of sports specific programs. Sports Performance Gift Certificates are perfect for the athlete in your life.
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.