Patient Forms

As a convenience to all of our patients, we have provided all of our Intake Forms online.

Please fill out all documents that are presented in each of the steps, and bring them with you to your Initial Evaluation Appointment. These forms are also available at our facility and may be filled out when you arrive on your first visit. If you prefer to fill out the forms at our facility, please arrive an extra 30 minutes before your appointment to allow for documentation time.        

(*) Signifies that document is required for intake.


All of In Motion Therapy Inc. Patient Forms are PDF files and require Adobe Reader in order to access. Please click here to safely download the latest version of Adobe Reader for free.


*Step 1:

Client Registration 

This form should be completed by all patients, new and returning, for your first therapy appointment. Please print, fill out, and bring with you to your first appointment. 

*Step 2:

Authorization to Treat

This form should be completed by all patients, new and returning, for your first therapy appointment. Please print, fill out, and bring with you to your first appointment. 

Step 3:

Medical History

This form should be completed by all patients, new and returning, for your first therapy appointment. Please print, fill out, and bring with you to your first appointment. 

*Step 4:

Medication List

This form should be completed by all patients, new and returning, for your first therapy appointment. Please print, fill out, and bring with you to your first appointment. 

*STEP 5 CLINIC INFORMATIONAL FORMS

Cancel Policy

Financial Information

Notice of Privacy Practices

Step 6 (*Required if Patient is a Minor): 

Consent for Treatment of a Minor

Request of Information (ROI) Form

Release of Information 

This form authorizes In Motion Therapy Inc. to release medical information securely as it pertains to you and your diagnosis, injury, or treatment.