Physical Therapy Fillable Patient Forms

All the required new patient forms you will need for your first visit are available online, right here on our website. We want to save you time when you come to see us, so we give you the option to fill the forms out at home and bring them with you when you come for your initial clinic visit. All you need to do is download the appropriate forms to your computer, type in the required information, print it, sign it, and bring it in.  Alternatively, you can come to your first visit 15 minutes early to fill out the forms.

Referrals and Authorizations for physical therapy are required for all Tufts Health and Blue Cross Blue Shield POS/HMO plans. Please have your Primary Care Physician (PCP), and not your specialty doctor (i.e. your orthopedic doctor), authorize treatment for Physical Therapy (PT), send the referral to your insurance company, and fax us a copy when this is complete to: 866-949-9835. The referral department at your PCP clinic needs three things in order to authorize PT treatment and complete the insurance referral:

  1. Clinic Name: We are Specialized Physical Therapy (SPT) located in North Reading, MA.
  2. National Provider Identifier (NPI): NPI is 156-871-0903.
  3. The patient’s start date for the initial evaluation; the referral and authorization can be dated as the initial evaluation date or earlier.

A Prescription – no more than 30 days old – for Physical Therapy is required regardless of payment type (i.e. cash, health insurance, auto accidents, or workers’ compensation). Please bring the prescription to your first visit or have your PCP fax it to our clinic: 866-949-9835

1. Patient Intake – Required
2. Health History – Required
3. Auto Accidents
4. Consent for Minor
5. Notice of Privacy Practices
Typing in these forms is a breeze thanks to the text-ready Adobe PDF forms designed in Adobe Acrobat X Pro. If you prefer, you can print the documents and fill them out by hand as well.

Please make sure that you have either Adobe Acrobat Reader or Foxit Reader installed before downloading and filling out the forms. To download one of these PDF readers:

Once your choice program has been downloaded and installed to your computer you will need to download each form and open them with the PDF reader. To do this follow these steps:

  • Right click the hyperlink for the form
  • Select “Save Link As” or “Download Link As”
  • Choose the desired location for the file and click “Save”
  • Launch the downloaded file with Adobe or Foxit Reader
    • Native PDF programs on Apple and Linux operating systems work equally well
  • Fill out the PDF forms
  • Save each completed form to your computer
  • Print and bring to your first clinic visit

Thank you for choosing Specialized Physical Therapy – we can’t wait to start Moving You Forward!

SPT is just minutes from Andover, Reading, North Andover, and Wilmington MA

Specialized Physical Therapy is conveniently located in North Reading, MA and also proudly serves residents in Andover, Reading, North Andover, Wilmington, Boxford, Burlington, Woburn, Stoneham, and Methuen, MA. We offer free and spacious parking located within a few steps away from our clinic’s door.

Schedule Your Appointment Today to Regain Freer Movement and Healthy Living!

Specialized Physical Therapy practices a comprehensive approach to total muscle, joint, and spine health. We are the preferred physical therapy clinic in Greater Boston, because we offer an extensive range of physical therapy services designed to restore your physical strength and mobility while reducing your pain. Our physical therapy clinic sets itself apart by:

  • Providing proven techniques for alleviating minor, major, acute, and chronic pain.
  • Specializing in sports medicine, manual therapy, post-surgical care, auto accidents, prenatal and postpartum conditions, orthopedic injuries and overuse injuries.
  • Maintaining a clean, comfortable, private and quiet clinic, making it ideal for private consulting, educating and performing the latest physical therapy techniques.
  • Focusing on your individual needs, not the bottom line, because we are a small, physical therapist-owned and family-oriented clinic.
  • Treating one patient at a time in our private treatment room to make sure that you get the personalized care and attention you need.
  • Completing your treatment from start to finish with only exceptional doctorate trained and fully licensed Massachusetts physical therapists that have excellent skills, breadth of knowledge, and invaluable experience to help you reach your goals and succeed.

Read Our Patient Successes!