Forms

All forms will be available through the online scheduler under “New Patient Evaluation”. Your time is valuable; please be as thorough as possible when completing the new patient forms to maximize your therapy appointment!

 

New Patient Intake

Medical history and consent to treatment

Dry Needling Consent

Consent to dry needling with VCPT

Direct Access

From the Texas State of Physical Therapy Examiners

Physician Referral

If you have an established relationship with a primary care provider or surgeon and would like for them to be involved in your care, please have this signed form faxed to (512) 675 - 4884 or emailed to HIPAA-secure verna@vcphysicaltherapy.com