830-249-7211
1411 South Main Street
Boerne, TX 78006
Fax: 830-249-4698
» For Patients : Patient Forms
For Patients

Patient Forms

New Patient Information & Workman’s Compensation Forms

Prior to your first appointment, please open, print and complete these information forms. Bring them with you so that we can serve you more efficiently.

Thank you!

PATIENT FORMS:

Please fill out ONE of the following functional reporting forms (PLEASE ask front desk for appropriate form to fill out!!

  1. Optimal Form- Any injury that would involve upper/lower body or balance issues
  2. Neck Index
  3. TMJ
  4. Back Index
  5. DASH (DIsability of Arm, shoulder or hand)
  6. LEFS (Lower Extremity Functional Scale
  7. ADLS (Knee Activities of Daily Living Scale)
  8. FAAM (Foot and Ankle Ability Measures 

MD FORMS:

The above forms are pdf files and require Adobe Acrobat Reader to open and download. If you don't have Adobe Acrobat Reader installed on your computer, click on the above graphic to download this free player.

After completing these forms you may do one of the following:

  1.   Email to billing@boernepti.com
  2.   Fax them to 830.249.4698
  3.   Mail them to:

Boerne Physical Therapy Institute
1411 South Main Street, Suite 102
Boerne, TX 78006

Thank you!

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