Required Forms for ALL REACT clients:

Please print and sign each form as acknowledgment of our policies and releases

HIPPA Notice of Privacy Practices

Medical Release

Media Release

Billing, Scheduling & Insurance - Financial Policies Acknowledgment

Cancellation Policy

No Self Harm Agreement

 

Applications:

Please complete the application that corresponds with your particular program of interest

Neuro-Restorative Application

Veteran Program Application

Group Training Applications

Physical Therapy Clinical Program Application (Neurological and Vestibular Rehab)

 

Additional Forms - Phoenix Initiative

Neurotransmitter Assessment Form

Metabolic Assessment Form

 

Additional Forms - Clinical Physical Therapy

Registration Form

Notice of Privacy Practice

Notice to Consent & Treat