Patient Forms

We look forward to meeting you as a patient in our office. Remember that most insurance companies require a written prescription from your physician so please bring that with you to your first appointment (evaluation). Click here to find out the Insurance Companies we are providers for. We encourage you to call your insurance company directly to verify your benefits.

Following are links to forms that are required at your first visit to our clinic. Please download the forms and complete them prior to your appointment. If you have any questions about the forms, feel free to call our office.

  • Patient Forms Print out and complete these forms and bring with you to your evaluation visit in our office.
  • Privacy Practices Our office is HIPAA compliant. Our Notice of Privacy Practices describes how medical information about you may be used and disclosed and how you can get access to this information. Please read it carefully.
  • Satisfaction Survey We welcome your input about the services you received while a patient at Cottage Grove Physical Therapy. Please download this form and mail it in to our office. All comments are anonymous.
  • Medical Record Request You have the right to request a copy of your medical record. We will honor these requests as promptly as possible. We do require notification in writing by completing an Authorization to Use and Disclose Patient Information which requires your signature and then can be mailed to our office or delivered personally.

Co-insurance or co-payments are expected at the time of each visit unless other arrangements are made.

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