Patient Forms
The following patient forms are available if you choose to review and complete prior to your visit.
If you know you will be participating in GyroStim you may complete the additional GyroStim forms.
Patient Consent Form and Bill of Rights (all patients)
Missed Appointments & Insurance (all patients)
MIPS Patient Questionnaire (all patients)
Medications List (Printable & double-sided for your wallet)
Please complete one or more of the following forms based on your conditions:
(If you are off balance and dizzy, complete both the dizziness & balance forms)
Ideally, these forms should be completed on the day of your visit for accuracy.
Headaches
Dizziness (spinning, wonky, disoriented)
Neck
Upper Extremities (hands, wrists, arms, elbows, shoulders)
Back
Lower Extremities (feet, ankles, legs, knees, hips)
Balance (unsteadiness not coming from your head)
The following are only for individuals who know they will be coming for GyroStim
GyroStim Consent Form
GyroStim Preparation Form
GyroStim Media Release (optional)
Medical release and request forms.
Medical Records Release Form (allows us to release your information to someone else)
Medical Records Request Form (allows us to obtain your records from someone else)
If you know you will be participating in GyroStim you may complete the additional GyroStim forms.
Patient Consent Form and Bill of Rights (all patients)
Missed Appointments & Insurance (all patients)
MIPS Patient Questionnaire (all patients)
Medications List (Printable & double-sided for your wallet)
Please complete one or more of the following forms based on your conditions:
(If you are off balance and dizzy, complete both the dizziness & balance forms)
Ideally, these forms should be completed on the day of your visit for accuracy.
Headaches
Dizziness (spinning, wonky, disoriented)
Neck
Upper Extremities (hands, wrists, arms, elbows, shoulders)
Back
Lower Extremities (feet, ankles, legs, knees, hips)
Balance (unsteadiness not coming from your head)
The following are only for individuals who know they will be coming for GyroStim
GyroStim Consent Form
GyroStim Preparation Form
GyroStim Media Release (optional)
Medical release and request forms.
Medical Records Release Form (allows us to release your information to someone else)
Medical Records Request Form (allows us to obtain your records from someone else)
Patient Education Booklet
Our 2019 Patient Education Booklet is now available for you to read or download. It contains lots of articles and information to help you with a variety of conditions that we diagnose and treat.
About Physical Therapy
Physical Therapy is a pretty broad field, but in general patients work with physical therapists for needs including pre-surgery strenghtening, post operation recovery, the treatment of sports injuries, vestibular disorders, and balance improvement. The best way to describe what physical therapy is and what you can expect during your treatment is to click here.
Choose a Good Physical Therapist
Selecting the right physical therapist can be a daunting task, but don't be discouraged. We have put together our tips for you in what we recommend you look for. These tips come from our experience as physical therapists, healthcare clinic owners, and patients of other medical specialties. First and foremost, you should know that it's perfectly OK to call and ask a practice these questions. Second, if you ask a healthcare provider about his or her credentials and the provider is offended, that's probably a big red flag that you may want to look elsewhere. Read our 5 tips for selecting a good physical therapist.
Patient Satisfaction Survey Results
All patients are asked to complete a patient satisfaction survey upon discharge from physical therapy. The questionnaire contains 10 questions using a scoring sytem of 1-5 where 1 is Very Dissatisfied and 5 is Very Satisfied. The survey targets 4 key areas; the office environment, insurance billing and payments, provider interactions, and physical therapy treatment. While our satisfaction scores remain consistently high, our testimonials tell you what our patients really think! See what other patients have said about us on our patient testimonials page.
Patient Satisfaction Survey
If you did not complete a patient satisfaction survey at the time of discharge, please take the time now to tell us what you think. We highly value your feedback and actively use it to monitor how we are doing. Click here to submit your feedback.
Medical Equipment Loan Closets
The following organizations provide equipment to patients who need medical equipment.
Medical Loan Closet of Henderson County
1225 7th Ave East
Hendersonville, NC
Open Tues - Fri 9:00am-4:30pm
Rent what you need! 90 day loans are $20 for Buncombe County residents and $10 for Henderson County residents.
(828) 692-9005
medicalloancloset.org
Clark’s & Alexander Chapel UMC Medical Equipment Lending Closet
25 Clark’s Chapel Church Rd
Weaverville, NC 28787
Wheelchairs, walkers, canes, commodes, benches, and more. Borrow up to 6 months at no cost. Donations welcome.
(828) 658-1351
clarkschapelweaverville.org
If you know of other organizations that provide additional services to patients in our area, please let us know by sending an email to [email protected]
Medical Loan Closet of Henderson County
1225 7th Ave East
Hendersonville, NC
Open Tues - Fri 9:00am-4:30pm
Rent what you need! 90 day loans are $20 for Buncombe County residents and $10 for Henderson County residents.
(828) 692-9005
medicalloancloset.org
Clark’s & Alexander Chapel UMC Medical Equipment Lending Closet
25 Clark’s Chapel Church Rd
Weaverville, NC 28787
Wheelchairs, walkers, canes, commodes, benches, and more. Borrow up to 6 months at no cost. Donations welcome.
(828) 658-1351
clarkschapelweaverville.org
If you know of other organizations that provide additional services to patients in our area, please let us know by sending an email to [email protected]