New Patient Forms

To make your visit easier and more productive for both you and your physical therapist, we ask that our patients print and fill out the “New Patient Form”, and bring it with them to their initial visit.

Please read and review the information below, and then print out our “New Patient Form” for your first visit.


Thank you for taking the time to fill out our New Patient Evaluation form. We appreciate that you have chosen us to treat you. Before you proceed, there are a few things that you need to know to make your appointment run smoothly:

  • In addition to your referral/prescription for Physical Therapy, please bring any other information your physician gave you for this referral (reports, office notes, etc.).
  • Fill out the paperwork on the New Patient Form prior to your appointment time. If your paperwork is not completed, please arrive at least 20 minutes earlier than your appointment time so we can assist you in competing the forms.
  • Your initial appointment will take about 1 hour and follow up appointment will last approximately 45 minutes.
  • The times we have given you for your evaluation and treatment are valuable to you and part of a full schedule for our therapists. If you know you will be late by more than 10 minutes behind the scheduled time, please call our office as soon as possible. If you arrive more than 15 minutes after your provided appointment time, we may need to reschedule your appointment.
  • If there are missed appointments without your notification (no call or no excuse), we may have to cancel your remaining visits and refer you back to your doctor to continue with your care. Therefore, if you need to cancel/reschedule your appointment, please call at least 24 hours in advance to allow us to offer your appointment time to other patients. We reserve the right to charge a fee of $25.00 for any no-shows (not calling to cancel appointment) and for cancellations with less than the 24 hours advance notice.
  • We are providers for a wide range of insurance carriers. Almost all require patient co-pay for physical therapy services. We make every attempt to assist you in determining your payment responsibility and your carriers Physical Therapy benefit as a service to our patients. However, it is your responsibility to know your policy benefits. Please come prepared to pay your portion of the Physical Therapy benefit at the time of service. Under certain circumstances we do offer payment plans. You can contact your insurance company via the 1-800 number on your insurance card if you have any questions about your physical therapy benefits.

And again, thank you for choosing ECRC Physical Therapy!