Therapy PoolWinter Springs Florida 2026

1. Click ‘Get Form’ to open the Therapy Pool form in the editor.
2. Begin by filling out the 'Participant/Patient Information' section. Clearly print your name, date of birth, address, city, state, zip code, and phone number.
3. Next, provide details for an emergency contact. Include their name, relationship to you, and phone number(s).
4. In the 'Physician Information' section, enter your physician's name, phone number, and address including city, state, and zip code.
5. Indicate which activities the patient may participate in by circling all that apply: Low Intensity, Medium Intensity, or Open Swim.
6. Confirm whether the patient has approval to use the pool within the specified temperature range by marking 'Yes' or 'No'.
7. Answer additional questions regarding equipment usage and intensity increase with 'Yes' or 'No'.
8. Finally, have your physician sign and date the form at the bottom.

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