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Intake Paperwork

We Look Forward To Working With You In Our Clinic!

Please complete the appropriate paperwork prior to your first appointment.

Documents for each appointment type are available in two formats-
Electronic files: Download, complete electronically, and send via email (requires Microsoft Word).
Printable files: Download PDF, print, complete by hand, and bring to first appointment.
*Please note, PDF Files are large and may take several minutes for all pages to download.



Physical Therapy Patients

Electronic File
Printable File


MEDICARE PATIENTS- Please also complete the following form:

Electronic File
Printable File

Health & Wellness Clients

Electronic File
Printable File


Running Academy Clients

Electronic File
Printable File


Movement Analysis Clients

Electronic File
Printable File


Injury Screens Clients

Electronic File
Printable File


Please note: Complimentary injury screens are not available Medicare, Medicaid, Tricare, Veteran Affairs, Medicare Advantage, or other plans that receive federal funding.
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Smith Physical Therapy + Running Academy