The Hand Therapy & Occupational Fitness Center
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Please download, print and complete each of the following 5 required forms prior to attending your first appointment. Thank you.
1.
PRIVATE INSURANCE PATIENT INFORMATION FORM
2.
ASSIGNMENT OF BENEFITS
3.
HEALTH HISTORY FORM
4.
FUNCTIONAL ASSESSMENT - depending upon the location of your injury, please complete just one of the following:
WRIST AND HAND Patient Rated Evaluation
ELBOW Patient Rated Evaluation
5.
APPOINTMENT REMINDER FORM
- please tell us if you would like reminders by either phone, text or email message.
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Home
Our Clinic
What is Hand Therapy?
Treatments a CHT Offers
Diagnoses a CHT Treats
TELEHEALTH
Forms
Medicare
Private & Self-Pay
Workers' Compensation
COVID-19 UPDATES
Contact Us
Store