FYZICAL THERAPY & BALANCE CENTERS OF JACKSONVILLE
  • Home
  • Location
  • Contact Us
  • Staff
  • Forms
  • Insurance
  • Facility
  • Services
    • In Motion Services
    • Physical Therapy Sessions
    • Massage Therapy Sessions
    • Common Conditions >
      • Shoulder >
        • Rotator Cuff Tendonitis
        • Rotator Cuff Repair
        • Acromioplasty
        • Shoulder Impingement Syndrome
        • Shoulder Instability
      • Hip >
        • Total Replacement
        • Bursitis
        • Groin Strain
        • Hip - Labral Tear / Repair
      • Knee >
        • Patellar Tendonitis
        • Chondromalacia
        • ACL/PCL Reconstruction
        • Total Knee Replacement
        • Knee - IT Band Syndrome
        • Knee - LCL MCL Sprain
      • Ankle / Foot >
        • Achilles
        • Jones Fracture
        • Plantar Fasciitis
      • Spine - Degenerative Disc
      • Degenerative Joint Disease
      • Leg Fracture or Stress Facture
  • Testimonials
  • Patient Survey
  • Favorite Links
  • For Sale
  • News!

New Patient Forms:

Print and complete these forms on your time. You can either fax or email the forms and your doctor’s referral to FYZICAL of Jacksonville prior to your first visit, or you can bring them with you to your first visit.

Fax number: (904) 223-2365
Email: therapy@inmotionjax.com or jaxpt@fyzical.com


All New Patients: please select, print and fill out both of the following forms:
New Patient Intake Form
New Patient Payment Authorization Form

Please select, print and fill out one of the following pain questionnaires:
(If you are being treated for difficulty with walking or balance, please fill out the leg pain questionnaire. Your therapist will then review the questionnaire and possibly do further testing during your evaluation.)
Back Pain Questionnaire
Neck Pain Questionnaire
Shoulder, Elbow, Arm, Wrist and Hand Questionnaire
Hip, Knee, Leg, Foot and Ankle Pain Questionnaire

Medicare Patients: please select, print and fill out the following form:
Medicare Disclaimer Form

United Healthcare Patients: please select, print and fill out the following form:
United Healthcare Patient Summary Form

Patients who are Minors (under 18 years old): Parent/Guardian please select, print and fill out the following form:
Parental Consent Form

Additional Forms, Notice of Privacy Practices, Adobe Reader Download:
Medications List
Patient Survey
Notice of Privacy Practices
FREE Adobe Reader Download
All material ©2016 In Motion Physical Therapy.

  • Home
  • Location
  • Contact Us
  • Staff
  • Forms
  • Insurance
  • Facility
  • Services
    • In Motion Services
    • Physical Therapy Sessions
    • Massage Therapy Sessions
    • Common Conditions >
      • Shoulder >
        • Rotator Cuff Tendonitis
        • Rotator Cuff Repair
        • Acromioplasty
        • Shoulder Impingement Syndrome
        • Shoulder Instability
      • Hip >
        • Total Replacement
        • Bursitis
        • Groin Strain
        • Hip - Labral Tear / Repair
      • Knee >
        • Patellar Tendonitis
        • Chondromalacia
        • ACL/PCL Reconstruction
        • Total Knee Replacement
        • Knee - IT Band Syndrome
        • Knee - LCL MCL Sprain
      • Ankle / Foot >
        • Achilles
        • Jones Fracture
        • Plantar Fasciitis
      • Spine - Degenerative Disc
      • Degenerative Joint Disease
      • Leg Fracture or Stress Facture
  • Testimonials
  • Patient Survey
  • Favorite Links
  • For Sale
  • News!