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16463 SW Boones Ferry Road   Lake Oswego, OR  97035   phone: (503) 699-2955
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New Patients
&
Patients who have not been seen in the past 12 months

If you are a new patient and have not been seen by our clinic before, or have not been seen within the past 12 months, we ask that you print out, complete, and bring to your appointment, the forms briefly described below.

1. Personal Information*:  Name, address, doctor's name, insurance information, etc.
2. Patient Privacy:  This is a standard privacy statement.
3. Information Authorization:  Complete this form if we would like us to send information to a medical provider.
4. Credit Policy:  Summit Physical Therapy's credit policy
5. Cancellation Policy:  Summit Physical Therapy's cancellation policy.
6.  Health Intake*:  A short self-evaluation of your current state of health.

*Even if you have been seen in the past 12 months, if you are seeking treatment for a new issue, you may be required to fill these forms out again.
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