Logo - Essex Physical Therapy - Physical Therapists
(802) 878-9572
1 Market Place, Suite 33
Essex Junction, VT 05452

Early and Late appointments, call for details!

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New Patient Forms

To expedite your visit to Essex Physical Therapy, please download the necessary forms below and bring the completed forms with you to your visit. These forms are important in order to save time at your appointment. If you do not have these with you, we will have you complete them before you see the therapist. It is imperative that we have all of this important information at our office as well as your signatures to authorize treatment and allow us to bill your insurance.

If you have any questions when trying to complete the forms, please bring them with you to your appointment and we will be happy to assist you.

All patients should complete a New Patient Information and a Health Intake Form.

Click on the forms below to download:

New Patient Information - Standard

New Patient Information – Workers Comp

Health Intake Form

Massage Health Intake Form

HIPAA Privacy Policy Practices

Personal Training Membership Registration

Pool Membership Registration

Strength & Conditioning Camp Registration

SAS Informed Consent-General


Excerise Class Waiver


Summer Strength Camp

Forms
All patients should complete a New Patient Information and a Health Intake Form.
Contact us if you have any questions about our forms.

 

New Patients - Physical Therapists