FAX: (406) 549-5392

Patient Forms

We have provided our patient forms online for you to download and complete before your first office visit.  This saves you the effort of filling out the forms after you get to the office.

Please click on the link below to download the forms and print them.  Please bring the completed forms with your insurance card, photo ID and physician referral to your first appointment.

Each form listed below is a Word (.docx) document.

PATIENT FORMS FOR FIRST VISIT

PATIENT INTAKE FORMS

*If you have been treated at Sapphire PT within the past 12 months and the information we have on file is still current, we do not need to update the Patient Intake Forms, however please complete the Medical History forms.

MOTOR VEHICLE ACCIDENT FORMS

*If you are being referred to physical therapy as the result of a motor vehicle accident, please fill out this paperwork to its entirety and bring with you to your first appointment. Keep in mind we will have to verify liability acceptance with the responsible insurance company prior to your initial visit.

WORK RELATED INJURY FORMS

*If you have been referred to physical therapy as the result of an injury you obtained on the job, please fill out this paperwork to its entirety and bring with you to your first appointment. Keep in mind we have to authorize your physical therapy with your claims examiner/adjuster prior to your initial visit.

RUNNING ANALYSIS INTAKE FORMS

*If you are scheduled for a Running Analysis with John, please fill out this paperwork to its entirety and bring it with you to your appointment. Please have the Running Analysis Package picked out when you come to your appointment as well. You can find the offered packages are under Specialties/Running Analysis.