Physical Therapy & Rehabilitation for Hinckley, Brunswick, Medina, North Royalton, Parma, Richfield, Seven Hills and Surrounding Areas

Patient Forms

Physical Therapy Room Millennium Rehabilitation Hinckley Ohio

Prepare for Your First Visit to Millennium Rehabilitation

Make your first visit at Millennium Rehabilitation run as smoothly as possible; please bring the following documents and forms regarding your background and medical history:

  • Insurance ID Card
  • Drivers license or State Photo ID
  • PT order (if provided by your physician)
  • List of Medications (if applicable)

REQUIRED FORMS – click to download and print the following forms for your visit:

Demographic Form Health Questionnaire Patient Acknowledgement

ADDITIONAL OPTIONAL FORMS – In order to get a good understanding of your pain and/or symptoms, please fill out the form/forms below that coincide with the area of the body your pain/symptoms are involved with:

Neck Index Back Index Lower Extremity Function Scale DASH (Arm, Shoulder, Hand)