Patient Intake Forms, Healing In Motion, PLLC
For the Wellness Program
Welcome and Directions
Consent Form
Health and History
HIM Intake Form
For Occupational Therapy and Physical Therapy
Welcome and Directions
HIPPA
Insurance Benefits Worksheet
Health and History
Pelvic Pain Questionnaire
HIM Intake Form
Informed Consent for OT and PT
Notice of Privacy Acknowledgement
Payment Policy for PT and OT