Lor therapy 2026

1. Click ‘Get Form’ to open the LOR Physical Therapy Intake Form in the editor.
2. Begin by filling in your personal information, including your last name, first name, and date of birth. Ensure accuracy as this information is crucial for your treatment.
3. Provide your home and billing addresses. If they are the same, you can leave the billing address blank.
4. Enter your primary phone number and an optional second phone number for communication regarding appointments.
5. Complete the emergency contact section if applicable, especially if the patient is a minor. Include their relationship to you.
6. Indicate whether you will be using insurance for your sessions and provide details about your insurance carrier(s) if applicable.
7. Fill out the medical history section by marking any relevant conditions that apply to you. This helps therapists understand your health background.
8. Rate your pain level on a scale from 1 to 10 in the Neck Disability Index section, ensuring to reflect accurately on how it affects daily activities.
9. Review all sections for completeness before submitting. Once finished, submit the form via email as instructed at the end of the document.

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