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One Stop Physical Therapy & Wellness
3300 Hamilton Mill Road, Suite 102-271, Buford, Georgia 30519
Phone or Fax:  770-888-9504       Email: info@onestopphysicaltherapy.com

Physical Therapy (PT) is a client care service provided in response to a wide range of medical care needs of clients of all ages regardless of gender, color, ethnicity, creed or disability.  The purpose of PT is to treat disease, injury and disability by examination, evaluation, diagnosis, prognosis and intervention.  PT treatment may consist of rehabilitative procedures, mobilizations, massage, exercises and physical agents to aid the client in achieving their maximal potential for recovery within their capabilities.  The PT can also provide Wellness rehabilitation via exercises and modalities under direct supervision from a skilled clinician.  The Wellness program implementation is designed according to client or client's Power of Attorney choices.

DEMOGRAPHIC INFORMATION

Gender
Is it ok to text you?
Do you have any pets?
Marital Status
Does Client have a POA (Power of Attorney)?
Is it ok to text to this number?

INSURANCE INFORMATION

Will Client Be Using Private Pay?

CLINICAL INFORMATION

Have you been hospitalized recently?
Any injuries or falls this year?
Have you ever had Physical Therapy?
Are you currently under Home Health (HH) care?
Are you currently on Hospice?

This information is correct to the best of my knowledge.

By entering your name above, you acknowledge & agree that it is will be used as your digital signature.

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