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PERFORM AX PHYSICAL THERAPY WELLNESS, PC 150 BAY SHORE RD. NORTH BABYLON, NY 11703Date: Patient Name: DOB: Address: (Street)(City, State)(Zip Code)Social Security Number: Home Phone: Cell Phone: Email:
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To fill out the Performax Physical Therapy Wellness form, follow these steps: 1. Obtain the Performax Physical Therapy Wellness form from the clinic or download it from their website.
02
Fill in your personal information, including your name, address, contact number, and email address.
03
Provide details about your medical history, including any current or past injuries, surgeries, or medical conditions.
04
Indicate any medications you are currently taking and any allergies you have.
05
Answer the questions regarding your current physical fitness level and any specific goals you have for therapy.
06
If applicable, provide information about your insurance coverage and policy details.
07
Review the completed form for accuracy and completeness before submitting it to the clinic.
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If needed, consult with the clinic staff for any clarifications or assistance in filling out the form.

Who needs performax physical formrapy wellness?

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Performax Physical Therapy Wellness is designed for individuals who require physical therapy services to treat and rehabilitate various physical injuries, conditions, or post-surgical recovery.
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It is suitable for individuals of all ages and activity levels who wish to improve their physical well-being, recover from injuries, or enhance their athletic performance.
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People with sports-related injuries, chronic pain, musculoskeletal problems, postural issues, or mobility limitations can benefit from Performax Physical Therapy Wellness.
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Performax Physical Therapy Wellness is a physical therapy and wellness center that offers services such as physical therapy, sports medicine, and rehabilitation.
Patients who have received services at Performax Physical Therapy Wellness are required to fill out the necessary forms.
Patients can fill out Performax Physical Therapy Wellness forms by providing their personal information, medical history, insurance details, and signature.
The purpose of Performax Physical Therapy Wellness forms is to gather relevant information about patients and their treatment to ensure proper care and documentation.
Patients are required to report their personal information, medical history, current health status, insurance details, and any relevant medical conditions.
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