Virginia Therapy and Fitness Center

Patient Registration Information:

Thank you for choosing Virginia Therapy & Fitness Center for your physical therapy needs. Bring bring the following items with you for your first appointment at VTFC:

1. Completed Registration Packet – (See Below)
2. Current Insurance Card
3. Physician Prescription/Referral for physical therapy

Patient Forms

Patients can select and print the appropriate forms on their home PC in advance of their first visit.

All patients should complete the entire General Registration Packet.

Each patient should also print and complete the approproate Injury Form.

General Registration Packet (Complete Packet - 6 Pages)

           Individual forms included in the General Registration Packet may be printed separately:
                     Patient Information Sheet (2 Pages)

       Patient Registration Form (1 Page)
                       Financial Policy (1 Page)
                       Financial Responsibility (1 Page)
                       Cancellation Policy and Insurance Waiver (1 Page)

Injury Forms - print and complete the form that applies to your injury

               Cervical Spine / Neck (Neck Disability Index)
               Lumbar Spine / Low Back (Oswestry Disability Index)
               Shoulder (Shoulder Functional Assessment)
               Elbow (Elbow Functional Assessment)
               Wrist & Hand (Wrist and Hand Functional Assessment)
               Hip (Hip Functional Assessment)
               Knee (1. Knee Functional Assessment) (2. Lysholm Knee Scoring Scale)
               Foot & Ankle (Foot and Ankle Functional Assessment)
               Vestibular / Balance (1. Vestibular Questionnaire) (2. Dizziness Handicap Index)

What to wear for your upcoming appointment(s):

~ Upper Body Injury – T-shirt
~ Lower Body Injury – Shorts
~ Neck Injury: Tank top
~ Mid-back Injury: T-shirt, sports bra (women)
~ Low Back Injury: T-shirt, shorts
~ Foot Injury: Shorts, athletic shoes, previous orthotics

V I R G I N I A T H E R A P Y A N D F I T N E S S C E N T E R

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