Patient Forms (Action Physical Therapy)

Serving Salinas, California ~ Call Us at (831) 758-5338

Patient Intake Form

Downloads

Title	Size
Acknowledgement of Receipt of Notice of Privacy Practices	89.07 KB
Patient Agreement Form	90.86 KB
Medical History Questionnaire	25.64 KB
Patient Satisfaction Survey	107.13 KB
Private Insurance Notice	54.67 KB
Patient Agreement Form (Spanish)	91.68 KB

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What our customers say...

“I was referred to Action Physical Therapy by my physician for vertigo. My dizziness was effecting my life to the extreme that I was having a difficult time driving myself. After one treatment with Aimee Hibino, MPT, my vertigo was completely subsided.” - William H.