Forms
A. Condensed Intake -- Required for 1st Visit (88 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. Health Questionnaire -- Required for 1st Visit (52 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. Outcome Survey for Patients seeking care for Neck Injuries (94 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. Outcome Survey for Patients seeking care for Upper Extremity Injuries (103 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. Outcome Survey for Patients seeking care for Back Injuries (93 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. Outcome Survey for Patients seeking care for Lower Extremity Injuries (120 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. 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. HIPAA Document (95 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.
