For your convenience, we have included links to our intake paperwork, records request, and administrative forms. We use DocuSign to ensure patient privacy and streamline our paperless workflow. If you download and complete the forms before receiving them from our team, please email the completed documents to reception@quinnpt.com.
PATIENT INTAKE FORMS
At the initiation of treatment with our team, intake forms will be sent via DocuSign. Should you want to print a copy, or send in a completed forms ahead of DocuSign receipt, please download and fill out all the forms in this package, includingConsent to Treat, our Privacy Practice Acknowledgment, and Financial Responsibility Agreement. For our Medicare insured patients, please complete the Medicare New Patient Intake.
If you attend physical therapy with our team multiple times or undergo multiple plans of care throughout the year, a new consent to care will need to be signed.
Our privacy policy can be read here: Notice of Privacy Practices
In addition to new patient intake forms, if receiving Pelvic Floor Physical Therapy services, please download and complete this additional consent form. Please find additional information about Pelvic Floor Treatment on our FAQ page.
ADMINISTRATIVE FORMS
To manage your health information securely and accurately, please choose and complete the appropriate form based on your request. Once completed, please submit the form to our office.
QOPT Authorization for the Release of Protected Health Information
Medical Record Amendment/Correction Request Form
If you have any questions or need assistance with these forms, please contact our office staff for guidance. Thank you for your cooperation.
