Margaret Haller,MSPT - Pediatric and Orthopedic Physical Therapy

Forms

We look forward to meeting you and hope you will find your rehabilitation journey at Margaret Haller, MSPT, PC a pleasant experience.


In order to facilitate your initial evaluation the following paperwork can be printed and filled out before your visit.  The following is required of all patients: 

1.   Patient Questionnaire
2.   Consent to Treatment
3.   Form of identification
4.   Physicians referral
5.   Insurance card

Parents or guardians of a patient 18 years or younger please include a "Consent to Treat a Minor" form. 

Medicare patients please provide us with a list of all medications, vitamins and herbals along with dosages, frequency and method of administration at the time of your initial visit.







































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