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Please arrive for your first appointment 20 minutes early for check-in and insurance verification. Download, print, and complete the applicable forms to bring to your first appointment. Descriptions of the forms are also provided below.


NEW PATIENT PAPERWORK FORMS:

 

  • Medical History Form –  This form must be completed by all new and returning patients. It gives us important information that your therapist needs to develop a treatment plan for your therapy.
  • Medication List Form –  Provides us with information on medication name, dosage, reason for taking, frequency, and how it is taken. This is important for your therapist to know in developing your treatment plan.
  • HIPAA Form –  This form describes how the health insurance information that you provide may be used and disclosed. This is required by the Health Insurance Portability and Accountability Act of 1996.
  • Medicare Cap Information Letter –  This is informational only, and does not require a signature. It describes the annual financial limit (cap) on therapy services that Medicare has in place.
  • Consent For Minors – OSI requires that a parent or legal guardian accompany any minor children to their medical appointment. If a parent is unable to accompany a minor child to an appointment, the parent or legal guardian must sign this form.

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ALSO PRINT THE FOLLOWING FORMS IF THEY APPLY TO YOU:

PELVIC FLOOR PATIENT:

PHYSICIAN FORMS:

REFERRAL FORM

This form is available for physicians to download if they run out of referral pads – Click here to download the OSI referral form –

If you are a physician and need more referral pads, please call 651-275-4706

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OSI Physical Therapy orthopedic center and orthopedic specialists are committed to meet your physical rehabilitation and exercise rehabilitation needs.