Patient Info / Forms
We are here to help you enjoy your life, pain-free! MCH Physical Therapy Clinic is dedicated to helping you identify the cause of your pain and creating a custom treatment program that will allow you to return to normal activities pain-free. To make a convenient appointment, simply call us today at (501) 223-8996 or click here to request an appointment.
At MCH Physical Therapy Clinic, we want to maximize your time with us! Please choose an option:
- If you would like to save time on your first visit, please complete the ONLINE REGISTRATION and print the OTHER FORMS that apply to you, fill them out, and bring them with you to your first appointment.
- If you don’t want to complete the online registration, you can just print out the Other Forms and bring those with you.
- If you want to complete all the paperwork at the appointment, please allow extra time before your appointment to fill them out here.
Please complete after you have scheduled your appointment.
If you want to save time at your first appointment, please download and print after you have completed the online registration.
Medical History Form
Consent to Treat a Minor
Arm, Shoulder, Hand Disablity Index (DASH) – Initial Visit
Fall Risk Self-Assessment
Lower Extremity Functional Scale – Initial Visit
Neck Disability Index – Inital Visit
Low Back Disability Index – Initial Visit
Shoulder Pain and Disability Questionnaire
Before Your First Visit
- Make a list of questions that you have to discuss on your first visit.
- List signs and symptoms that can be of importance to the therapist.
- Have in writing key past medical history, previous treatments, current medications, and other important information.
- Please call our office to verify your insurance benefits.
- Arrive 15 minutes early for your first appointment.
- Bring with you a copy of your insurance card and a photo ID.
What to Expect on Your First Visit
- You will register with our friendly front office staff. They will help you navigate the insurance process and treatment program so you can focus on your recovery.
- You will meet with our physical therapist for the initial evaluation.
- During the evaluation, your therapist will ask questions about your medical history, current pain, or injury. Open communication helps us understand your problem.
- Your movement, strength, coordination, and much more will be evaluated. Our purpose is to help you, so please ensure you inform your therapist if anything is hurting or bothering you during the examination.
- Your therapist will recommend and prepare a course of treatments to ensure the quickest recovery and the best results. Your therapist will discuss the recommendations with you.
- There may be some limited treatments performed on the first day to get you started on your road to recovery. However, during the next visit, you will get into the full swing of your treatment plan.
- You will schedule your series of visits with the front desk. The amount of therapy needed will be discussed with you, depending on the recommendations of your therapist. We offer many convenient appointment times, however, prime times can become busy, so it is best to book ahead as much as possible.
- Your therapist will write up their findings and treatment plan to submit to your referring physician or another medical professional who you choose.
- If you have any questions at any time, please don’t hesitate to call. We want to ensure your satisfaction and full recovery.