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Welcome to ProActive Physical Therapy & Performance Center!

Please print and fill out all pages of the

Medicare Intake Forms

ALSO, please select one of the following forms that best represents why you are coming for treatment.


                Neck Pain Form


                Back Pain Form


                Upper Extremity Pain Form  (shoulder, elbow, wrist, hand)


                Lower Extremity Pain Form   (hip, knee, ankle, foot)


                Dizziness/Vertigo Form

**Please bring your completed forms, along with your ID, insurance cards, and physician referral to your initial appointment.


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