Shippensburg Physical Therapy
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Intake Forms

We value your time and your privacy. Therefore, we have provided our new patient forms for you to download, print, and fill out at home. Please bring them into our clinic during your next visit.
Medical History Questionnaire
File Size: 61 kb
File Type: pdf
Download File

Patient Information Form
File Size: 525 kb
File Type: pdf
Download File

Privacy Practices Brochure
File Size: 503 kb
File Type: pdf
Download File

Therapy Participation Form
File Size: 658 kb
File Type: pdf
Download File

Visual Pain Scale Form
File Size: 143 kb
File Type: pdf
Download File

Medicare Medication List Form
File Size: 449 kb
File Type: pdf
Download File

Disability Indices

For your convenience, we have provided a variety of injury forms for you to download, print, and fill out at home. Please bring them into our clinic, along with your intake forms, during your next visit.
Ankle Foot Injury
File Size: 31 kb
File Type: pdf
Download File

Hand Injury
File Size: 57 kb
File Type: pdf
Download File

Knee Injury
File Size: 55 kb
File Type: pdf
Download File

Hip Injury
File Size: 74 kb
File Type: pdf
Download File

Knee Injury Surgery
File Size: 46 kb
File Type: pdf
Download File

Lower Back Injury
File Size: 70 kb
File Type: pdf
Download File

Neck Injury
File Size: 82 kb
File Type: pdf
Download File

Shoulder Injury
File Size: 49 kb
File Type: pdf
Download File

Upper Extremity Injury
File Size: 53 kb
File Type: pdf
Download File

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LOCATION

20 Park Pl #2,
​Shippensburg, PA 17257

TELEPHONE

(717) 477-8030

CONNECT

© 2022 Shippensburg Physical Therapy & Sports Medicine. All rights reserved.
  • About
  • Services
  • Forms
  • Industrial Medicine
  • FAQ'S
  • Staff
  • Contact