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.
There are two ways you can fill out a form before your visit. First, you can fill out an online form (coming soon). The information you provide here will be entered into our computer systems and you will only need to verify that the information is correct at the time of your visit. Your submission of personal information is secure with 128 bit encryption over a secure socket (https://). Second, if you would rather not complete the forms online, you can simply click on the PDF icon, print the form out, and bring the completed form with you to your scheduled appointment.
Registration Forms (required)
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.
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.