Direct Access Physical Therapy & Pain Management Centers
Direct Access Physical Therapy &Pain Management Centers

INTAKE FORMS

In an effort to save you time, please review and fill out these forms at home and bring them to your first appointment.

Client Information, Insurance forms.pdf
Adobe Acrobat document [53.9 KB]
Medical History From.pdf
Adobe Acrobat document [38.7 KB]
Consent for Care and Treatment Financia[...]
Adobe Acrobat document [33.4 KB]
Acknowledgement of Receipt of Notice of [...]
Adobe Acrobat document [43.7 KB]
HIPAA Notice (2).pdf
Adobe Acrobat document [529.2 KB]

Contact Us Today!


5327 North Sheridan Road

Suite A
Chicago, Illinois 60640
 


5555 North Sheridan Road

Suite 24

Chicago, Illinois 60640
 


6374 North Lincoln Avenue

Suite 305

Chicago, Illinois 60659
 


Telephone (773) 944 0484

                  (872) 208 3095

 

Fax            (773) 944 0484

                  (773) 961 8346

 

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Direct Access Therapy, Inc.| Physical Therapy, Rehabilitation & Pain Management Clinics