Forms

All patient forms you may need to get started on your manual physical therapy plan with OMT Specialists can be found below. If you have any additional questions about our practice or want to get in touch with one of our licensed physical therapists, please call (240) 454-3806 or contact us online today!

Automobile Accident or Personal Injury Protection and Worker’s Compensation Claims

Patient and Therapist Agreement of Office Policy

Patient and Therapist Agreement of Office Policy, Consent for the Use or Disclosure of Protected Health Information, Billing and Payment Policy, Automobile Accident or Personal Injury Protection and Worker’s Compensation Claims, Privacy Policy Acknowledgement, Office and Patient Payment Agreement

Billing and Payment Policy

Confidential Information

Consent for the Use or Disclosure of Protected Health Information

Medical History

Medical Questionnaire

Neck Disability Index
Neck Disability Index (Page 2)

Oswestry Low Back Pain Disability Questionnaire
Oswestry Low Back Pain Disability Questionnaire (Page 2)

Office and Patient Payment Agreement

Privacy Practice Acknowledgement

Shoulder Pain and Disability Index