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New Patient Form

Medical History
Medical History
Is this related to an auto accident?

The Health Insurance Portability and Accountability Act (HIPAA) provide safeguards to protect your privacy. Implementation of HIPAA requirements officially began on April 14, 2003.

Assignment of Benefits:  I assign all benefits to Excel Physical Therapy, Inc. I authorize release of records to any agency involved in the payment of treatment for the patient named below. I understand in the event that collection is necessary, I am responsible for all collection and attorney fees accrued on my account

No Show Cancellation Policy

There will be a $25 fee charged to your account for any no shows or for appointments not cancelled at least 24 hours prior to the appointment

New Patient Form

Please complete this form prior to your first appointment. Download to print and complete this form, or scroll down to complete the form online. 

Excel Physical Therapy

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© 2023 Website and marketing by The Bowerbird Agency

Hours of Operation
Mon: 8am to 5pm
Tues: 8am to 5pm
Wed: 8am to 2pm
Thurs: 8am to 5pm
Fri: 8am to 5pm
Closed for lunch 12pm to 1pm
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