Forms
A. Physical Therapy Condensed Intake -- Required for 1st PT Visit (75 KB)
You will be required to sign this form at your first visit.
If you would like to expedite the paperwork process at your first visit, print this form, read it, sign it and bring it to your 1st visit.
If you have questions about the content of this form, you can ask at your first visit or email info@jointventurespt.com.
B. Physical Therapy Health Questionnaire -- Required for 1st PT Visit (96 KB)
You will be required to fill out and sign this form at your first visit.
If you would like to expedite the paperwork process at your first visit, print this form, fill it out the best you can, sign it and bring it with you to your 1st visit. If you have questions about the content of this form, you can ask at your first visit or email info@jointventurespt.com.
C1. Physical Therapy Outcome Survey for PT Patients seeking care for Neck Injuries (82 KB)
If you have a neck injury, please print and fill out this form prior to your first visit and bring it with you. If you have any questions, you can ask at your first visit or email info@jointventurespt.com.
C2. Physical Therapy Outcome Survey for PT Patients seeking care for Upper Extremity Injuries (90 KB)
If you have an upper extremity injury (shoulder, upper arm, elbow, forearm, wrist, hand or fingers), please print and fill out this form prior to your first visit and bring it with you. If you have any questions, you can ask at your first visit or email info@jointventurespt.com.
C3. Physical Therapy Outcome Survey for PT Patients seeking care for Back Injuries (81 KB)
If you have a back injury (upper or lower), please print and fill out this form prior to your first visit and bring it with you. If you have any questions, you can ask at your first visit or email info@jointventurespt.com.
C4. Physical Therapy Outcome Survey for PT Patients seeking care for Lower Extremity Injuries (115 KB)
If you have a lower extremity injury (hip, thigh, knee, lower leg, ankle, foot, toes), please print and fill out this form prior to your first visit and bring it with you. If you have any questions, you can ask at your first visit or email info@jointventurespt.com.
D. Physical Therapy Demographic / Phone Intake Information (200 KB)
You do not need to do this form in advance. The information you gave on the phone will appear on page 1 and you will be asked to verfiy the information and sign this form. Joint Ventures will also take the information you gave over the phone and verify your payor information. Page 2 will include your financial responsibility for your care once your health benefits have been verified.
E. Physical Therapy HIPAA Document (82 KB)
This form contains Joint Ventures' policy about using your protected Health Information.
We are required by federal law to make this form available to you.
You do not need to print this form and you do not need to bring it to your first appointment.
If you have questions about this form, you can ask at your first visit or email info@jointventurespt.com.
F. Massage Therapy Intake and Informed Consent (142 KB)
You will be required to fill out this form at your first massage visit and anytime you have a change in your medical status or goals for a massage. If you have any questions, you can ask at your visit or email info@jointventurespt.com.
G. Chiropractic Intake and Informed Consent for Dr. Pete Viteritti (437 KB)
You will be required to fill out and sign this form at your first chiropractic visit with Dr. Pete Viteritti. If you have any questions, you can ask at your 1st visit or email Dr. Pete Viteritti directly at pete.viteritti@jointventurespt.com.
H. Chiropractic Intake Paperwork for Dr. Chung Lee & Dr. Peter Chiang (234 KB)
You will be required to fill out these forms at your first chiropractic visit with Dr. Chung Lee or Dr. Peter Chiang. If you have any questions, you can ask at your first visit or email Dr. Chung Lee directly at chung.lee@jointventurespt.com or Dr. Peter Chiang at peter.chiang@jointventurespt.com
I. Acupuncture Health Questionnaire and Informed Consent (313 KB)
You will be asked to fill out these forms prior to your first visit. They ask questions about your current and past health and give your informed consent to treat you. If you have any questions about the forms, you can ask when you arrive for your first visit or you can email your acupuncturist directly. Check out the Staff tab on our homepage to get their email address.
J. Personal Training Informed Consent (84 KB)
You will be required to sign this form prior to your first personal training appointment. It gives your consent for the Joint Ventures' personal trainer to work with you. You will only need to fill it out once. If you have any questions about this form you can ask when you arrive for your visit or you can email your personal trainer. Check out the Staff tab on our homepage to get their email address.
K. Personal Training -- Keith Colby's Welcome Packet (137 KB)
You will be required to fill this form out prior to your first personal training session with Keith Colby. This form gives Keith important information about your current condition and goals. It also reviews Keith's policies. You will only need to fill it out once during your course of treatment. If you have any questions about this form you can ask when you arrive for your visit or you can email Keith at keith@jointventurespt.com.
L. Nutritional Counseling Informed Consent (123 KB)
You will be required to sign this form prior to your first nutritional counseling appointment. It gives your consent for the Joint Ventures' nutritionist to treat you. You will only need to fill it out once during your course of treatment. If you have any questions about this form you can ask when you arrive for your visit or you can email your nutritionist. Check out the Staff tab on our homepage to get their email address.
