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.
- New Patient Information Form - Used to verify insurance benefits
- Workman's Compensation Form - (Fill out if a Workman's Comp Injury ONLY)
- Medical History Form (updated 2016)-ALL PATIENTS WHO WOULD LIKE TO SAVE SOME TIME DOING THEIR INTAKE PLEASE FILL THIS OUT PRIOR TO YOUR FIRST VISIT!
Please fill out ONE of the following functional reporting forms (PLEASE ask front desk for appropriate form to fill out!!
- Optimal Form- Any injury that would involve upper/lower body or balance issues
- Neck Index
- Back Index
- DASH (DIsability of Arm, shoulder or hand)
- LEFS (Lower Extremity Functional Scale
- ADLS (Knee Activities of Daily Living Scale)
- FAAM (Foot and Ankle Ability Measures
- New Patient Referral Form - This form is for MD's, or for patient to take to MD for referral to BPTI
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:
- Email to firstname.lastname@example.org
- Fax them to 830.249.4698
- Mail them to:
Boerne Physical Therapy Institute
1411 South Main Street, Suite 102
Boerne, TX 78006