Patient Registration Forms

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For your convenience, the following forms are available for download. Prior to your appointment the Patient Functional Assessment Questionnaire and Rehabilitation Screening/Confidential Medical History must be completed and signed. Also, the Patient Notification, Financial Policies and the Notice of Privacy Practices must be read and signed.

Patient Functional Assessment Questionnaire
Rehabilitation Screening/Confidential Medical History
Patient Notification
Financial Policies
Notice of Privacy Practices
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Once you have completed the forms:

Fax:
530-224-2229

Mail:
Liberty Physical Therapy
1255 Liberty Street
Redding, CA 96001

You should receive a call within 1 business day of receipt confirming we have received your form. If you have any questions, please call 530-224-2226.