Patient Forms

These are the general information forms that you will need to complete and sign before being treated.

1. Patient Intake Forms

2. Telehealth Appointments Only: Telehealth Consent Form

    • Fill out the telehealth consent form prior to your appointment. You can print it off, sign it, make a copy (i.e., take a phone photo or make a scan), and email it back to us. Or, if you prefer (and know how), you can digitally sign it and email it to us. Please email the form to epttelehealth@gmail.com.
    • Directions to learn to sign PDF and Word Documents digitally:

PDF – https://www.wikihow.com/Digitally-Sign-PDF-Documents

Word – https://www.wikihow.com/Add-a-Digital-Signature-in-an-MS-Word-Document

3. Depression Scale

4. 65 and Older Only: Elder Abuse Scale

5. Next, select the appropriate additional forms that best suit your condition and situation. You must fill out the main document and also the corresponding *Foto document (e.g., if you are seeing us for a knee issue, click and fill out the main knee document as well as the *Foto knee document):

*Foto – Hip Knee Foot, Ankle

*Foto – Lumbar

*Foto – General Orthopedic

*Foto – Shoulder Elbow, Wrist, Hand