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CAM Physical Therapy and Wellness Services, LLC Patient Registration (Please Print) Today's Date Email Address Name (Last, First, M.I.) Phone # () Alternate Phone # () Address City State ZIP SSN Sex
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To fill out the CAM physical therapy form, follow these steps:
02
Start by entering your personal information, such as your name, address, and contact details.
03
Provide your insurance information, including the name of your insurance company and your policy number.
04
Specify the reason for seeking physical therapy, such as an injury or specific condition that requires treatment.
05
Mention any previous medical history or surgeries that may be relevant to your current condition.
06
Answer any questions about your current symptoms or pain levels, providing detailed information to help the therapist understand your situation better.
07
Indicate any medications you are currently taking, including dosages and frequencies.
08
Provide information about any allergies or sensitivities you have, especially if relevant to the treatment.
09
Sign and date the form to confirm the accuracy of the provided information.
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Remember to consult with your therapist or healthcare provider if you have any doubts or questions while filling out the form.
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CAM physical therapy form is needed by individuals who require or wish to undergo complementary and alternative medicine (CAM) physical therapy.
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This form allows healthcare providers to gather essential information about the patient's medical history, current condition, and treatment preferences.
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It helps determine if CAM physical therapy is an appropriate course of treatment and assists the therapist in developing an individualized treatment plan.
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Anyone who seeks CAM physical therapy should fill out this form to ensure their therapist has a clear understanding of their health status and treatment goals.
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