Elevate Physical Therapy
Dr. Pamela Bentley, Physical Therapist

Patient Intake Form

Please click the button to download, fill out and print form to bring with you at your first visit.

Intake Form

Physical Therapy Informed Consent

Please click the button to download, fill out and print form to bring with you at your first visit.

Informed Consent

Dry Needling Consent

Please click the button to download, fill out and print form to bring with you at your first visit.

Dry Needling Consent

Financial Responsibility and Cancellation Policy

Please click the button to download, fill out and print form to bring with you at your first visit.

Cancellation Policy

Authorization and Consent to Treat a Minor

Please click the button to download, fill out and print form to bring with you at your first visit.

Consent for Minor

I will let you know which outcome
measure you may need to fill out for your first visit from the forms below. 

Dizzy Outcome Measure 

Please click the button to download, fill out and print form to bring with you at your first visit.

Dizzy form

Upper Extremity Outcome Measure 

Please click the button to download, fill out and print form to bring with you at your first visit.

Upper Extremity form

TMJ Outcome Measure

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TMJ form

Neck Pain Outcome Measure

Please click the button to download, fill out and print form to bring with you at your first visit.

Neck form

Lower Extremity Outcome Measure

Please click the button to download, fill out and print form to bring with you at your first visit.

Lower Extremity form

Low Back Outcome Measure

Please click the button to download, fill out and print form to bring with you at your first visit.

Low Back form