Download Patient Registration:

Once you have received an appointment to be evaluated at our office, for your convenience, we offer pre-registration. This reduces the paperwork the first time you meet our staff. Our registration includes patient and insurance information and the patient agreement. Furnace Brook P.T. follows all regulations concerning HIPAA compliance and you will be asked to sign your disclosure form upon arrival to the clinic.

Choose from the Following:

OR Option 1 enables you to submit the information to us and sign upon your arrival.   Option 2 downloads the forms to your computer. You may print, sign and mail the forms, or you may bring them with you completed the first day.

 

Please be assured that every precaution has been taken to ensure the security
of this form through SSL.

You will need Adobe Acrobat Reader to view the pdf printable versions of option 2. To download this software, please click here. Adobe Acrobat is FREE.