Patient Forms

The PT Center understands that your time is valuable. In order to make your clinic visit more worthwhile, we've included some useful forms that you can download and prepare in advance of your appointment.

Please bring the completed forms to The PT Center at the time of your appointment. Our friendly clerical staff will take it from there.

The following documents are available as PDF files using Adobe Acrobat Reader. If you do not have Adobe Acrobat Reader, download a free copy from Adobe.

There are two ways for you to see the therapists at The PT Center:

  • Referral by a Healthcare Provider (see list below)
    • Physician (MD, DO)
    • Physician Assistant (PAC)
    • Nurse Practitioner (NP, ANP, PNP, FNP, GNP)
    • Naturopathic Physician (ND)
    • Chiropractor (DC)
    • Podiatrist (PD)
    • Dentist (DDS, DMD)
  • Self Referral (Direct Access)

What is Direct Access:

This term refers to your ability to see a Physical Therapist (PT) without a physician's referral. Ohio is one of 44 states and the District of Columbia that allow physical therapists to evaluate and treat, under certain conditions, patients without a referral from a physician. This means that any patients has the legal right to seek out services from any PT they wish to see.

Ohio's direct access law has a few restrictions. After the initial evaluation, the physical therapist must inform the patient's physician of his or her findings within five days. And, if there is no subsequent progress in the patient's condition after 30 days, the physical therapist must consult with or refer the patient to a doctor.

The best ways to know what your insurance plan will cover if you decide to utilize Direct Access is to call them. In many states with Direct Access, insurance companies are now reimbursing because they realize that it costs less when you have the choice to access physical therapy without a delay.

Appointments Available:

Monday thru Thursday - 7am to 6:30pm

Friday - 7am to 11am

Saturday - 8am to 10:30am