North Royalton Office: 5340 Royalton Road • North Royalton, OH 44133 • PH 440-230 -1133 • Fax: 440-230-9243 • Email: info@src-pt.com
  Sports Rehabilitation Consultants - Columbus, Ohio
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WELCOME TO SRC!:

Thank you for choosing Sports Rehabilitation Consultants Physical Therapy (SRC) for your care and rehabilitation.

If you have not already called our office to schedule an appointment - for your convenience you can now register online.

Simply go to the New Patient Portal Tab.   Click the Portal Tab and follow the registration directions.   A member of our Front Desk Team will then contact you to answer any questions you may have, schedule your appointment and inform you of what documents below you will need to download, print, complete & sign to bring with you on the day of your scheduled appointment.

These new patient forms below are provided for your convenience to complete at home and are required in order for you to begin physical therapy.

Due to our new electronic medical records system all registration forms must be completed prior to your appointment time and are due at check in.  Also please plan to arrive at least 15 minutes early for your first appointment  in order for us to process the paperwork and answer any questions you may have.

Please remember to bring the following with you:

  • Completed New Patient Forms

  • Photo ID

  • Your Insurance ID

  • Your physicians order for physical therapy.

  • A current list of medications you are taking

Important Note:  If you inadvertently forget to bring in your completed forms and/or they are not completely filled out when you arrive for  your appointment time - we may need to reschedule your appointment.

The following forms located at the bottom of the list below should be downloaded and completed based on your condition/injury:  Disabilities of the arm, shoulder and hand form (DASH); Neck Index; Back Index; Lower Extremity Functional Scale (LEFS).

Click on the form names below to download:

New Patient Demographics & HIPAA Forms

Physical Therapy Patient Information Form

Medical history/ Subjective information form

Patient SRC Financial and Cancel Policies

Disabilities of the arm, shoulder and hand form

Neck Index

Back Index

Lower Extremity Functional Scale

Again, thank you for choosing Sports Rehabilitation Consultants Physical Therapy!

Sincerely,

Sally & Your Sports Rehab Consultants Team

 

 

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   Sports Rehabilitation Consultants