Patient Forms


All new patients will be asked to provide personal information to assist our therapists in providing the highest levels of care aimed at achieving your goals.  Please be as specific and detailed as you can be in preparing these forms.  For your convenience, our admission forms are available for downloading and completing before your first appointment.  

In order to view and print the following forms, you will need Adobe Reader.  A free version is available by clicking HERE.

We are participating providers with Blue Cross Blue Shield, Medicare, Ambetter, Tricare, Healthgram, and Medcost. We accept other insurances as an out-of-network provider. Please check with your carrier prior to your first appointment to verify that you are eligible for out of network benefits if you have insurance other than BCBS, Medicare Ambetter, Tricare, Healthgram, or Medcost. We can not accept Medicaid.

For your convenience, we have provided a copy of our privacy practices below.  This document describes how medical information about you may be used and disclosed and how you can get access to this information.

Please call us at 919.535.3930 with any questions concerning the requested information on these forms.