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PERFORM AX PHYSICAL THERAPY WELLNESS, PC 150 BAY SHORE RD. NORTH BABYLON, NY 11703 Date: Patient Name: DOB: Address: (Street)(City, State)(Zip Code)Social Security Number: Home Phone: Cell Phone:
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To fill out the Performax physical therapy form, follow these steps:
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Start by entering your personal information such as name, address, phone number, and date of birth.
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Provide details about your medical history, including any past injuries, surgeries, or chronic conditions.
04
Indicate your current symptoms or issues that require physical therapy.
05
Mention any medications you are currently taking.
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Fill out the insurance information section, including your provider's name and policy number.
07
If applicable, provide information about your primary care physician and any referring doctor.
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Sign and date the form to certify the accuracy of the information provided.
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Make sure to review the completed form for any errors before submitting it.
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Submit the filled-out form to your physical therapy provider or healthcare facility.

Who needs performax physical formrapy and?

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Performax physical therapy form is needed by individuals who require physical therapy services.
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This may include patients recovering from surgeries, accidents, or injuries.
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People with chronic conditions or musculoskeletal disorders can also benefit from physical therapy.
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Athletes looking to enhance their performance or prevent injuries may require this form as well.
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In short, anyone who needs personalized physical therapy treatment can utilize Performax physical therapy form.
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Performax physical therapy is a type of therapy that focuses on improving physical function and mobility.
Performax physical therapy is typically prescribed by a healthcare provider for individuals who have experienced injuries or illnesses affecting their physical abilities.
To fill out performax physical therapy forms, patients will need to provide information about their medical history, current physical condition, and treatment goals.
The purpose of performax physical therapy is to help individuals improve their physical function, reduce pain, and regain mobility.
Information reported on performax physical therapy forms may include personal information, medical history, current physical limitations, and treatment progress.
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