Please fill out the interactive “New Patient Health Form” and the questionnaire specific to the body part we are examining. Once filled out, save the PDFs and email them as an attachment to  If you choose to bring them with you to your appointment, please arrive 20 minutes prior to your scheduled time.

IMPORTANT: If you are emailing your forms it is important you save them first and then send them as an attachment, otherwise the form arrives blank.

All patients should bring their insurance card and a driver’s license.  Please also bring any prescriptions for physical therapy from your referral source (if applicable).

New Patient Health Form

2000 IKDC Knee Pain Scale

Back (Oswestry)

Berg Balance Scale

Hip-Ankle-Foot (LEFS)

Neck (Oswestry) Pain Scale

Shoulder-Elbow (PENN) Master


United Healthcare Patients also need to complete:

Patient Summary Form

DASH Questionnaire

Please print and bring these two forms along with your other paperwork.  We are currently working to provide interactive UHC forms. Thank you for your patience!

Jeff Baker, Omaha Police Sergeant

“As a police officer of 25 years, my ability to defend myself and others is paramount. With a lesser qualified clinic or less committed therapists, I fear my rehabilitation would have taken much longer, and would have left me an incomplete athlete.”