New Patient Forms

Whenever possible, please complete the new patient paperwork ahead of time. This will allow us to devote the maximum amount of time to your appointment. The easiest and most efficient way to do this is through the link that was sent to you in your appointment confirmation text or e-mail.

Other options include filling the forms out on your computer and e-mailing them to kelly@activedelmarpt.com, or printing out the forms and bringing them with you to your first visit.

Patient Demographics

Medical Profile Questionnaire

Notice of Privacy Practices (no signature required)

Acknowledgement of Privacy Practices (signature required)

Financial Policies

Patient Specific Functional Scale

New York State Law allows patients to see a physical therapist for up to 10 visits, or 30 days from the start of care (whichever occurs first) without a referral from a physician, physician’s assistant, or nurse practitioner. Please call us for more detailed information relating to Direct Access in New York State.

If you see a physician first, feel free to use the following downloadable referral form.

Referral form