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Forms at Campus Physical Therapy Center

Filling out our forms prior to your scheduled appointment will not only save you time on the day of your appointment but also reduce the stress and provide more accurate information to your Physical Therapist.

 

Registration Forms (required)

campus physical therapy

The following forms establish a financial agreement form between you, the patient or legal guardian, and Campus Physical Therapy Inc. If you prefer to provide payment through your insurance company, please provide the most up to date information gather from your latest contract.

 

 

 

Privacy Practice Forms

These is a federally mandated form that assure your privacy.

Privacy Practice Form

Workers Compensation Forms

Campus Physical Therapy Inc. may direct you to obtain one or more of these forms to be completed by you and/or your treating physician.

California Workers Compensation DWC 1
California Workers Compensation PR 2

Other Forms

If you need your medical records, please complete the form below. A medical record fee of $60.00 is required. If you have an attorney, please ask him/her to send us a formal request along with the medical record fee and a release form signed by you, the patient or legal guardian.

Request of Medical Records

Financiall Hardship Form Financial Hardship Form