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Patient Forms

Whether you are a new patient to our clinic or haven't been seen in a while, we will need patient information.  Please find the forms below to complete prior to your appointment whenever possible. 

  • As a new patient to our clinic, you will need to fill out a REGISTRATION FORM and a HEALTH QUESTIONNAIRE

  • If you are a returning patient, please fill out an updated HEALTH QUESTIONNAIRE. Additionally,

  • All patients new and returning will need to fill out the FUNCTIONAL SCALE (found in the section labeled Functional Scales) that most closely corresponds to your injury as well as review and sign the HIPAA FORM.

  • If you are interested in DRY NEEDLING as a component of your treatment, you will also need to sign the consent form for DRY NEEDLING.

  • Medicare and Medicare Advantage patients will additionally need to fill out PHQ-9 FORM

THE CLINIC

4735 Perkins Road

Baton Rouge, LA 70808

225.923.0110

Fax 225.923.0111

info@go-physicaltherapy.com

Hours of Operation:

Mon - Thur: 7am - 5:30pm

Friday: 7am - 12:00pm 

​​Saturday: Closed ​

Sunday: Closed

CONTACT

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