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Premier Physical Therapy and Sports Rehab, Inc. 1017 Ashes Dr. Suite 101 Wilmington, NC 28405PATIENT INFORMATION CONSENT FORM I have read and fully understand Premier Physical Therapy and Sports Rehab,

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To fill out the Premier Physical Therapy form, follow these steps:

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Start by entering your personal information such as your name, address, and contact details.

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Provide your medical history and previous injury details, if any.

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Indicate any current medications or allergies you have.

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Mention your insurance information, including the name of the insurance company and your policy number.

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Specify the reason for seeking physical therapy and describe any symptoms or limitations you are experiencing.

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Answer the questions regarding your current physical condition and any related medical treatments.

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Premier Physical Therapy form is needed by individuals who require physical therapy services.

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This may include individuals recovering from injuries, those with chronic pain or mobility issues, athletes aiming for sports rehabilitation, or anyone seeking to improve their overall physical well-being.

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The form helps the physical therapy professionals to assess the patient's condition and design a suitable treatment plan.

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