Please print, fill out and bring with you to your first appointment the appropriate medical history intake form located below:
- Patient History Questionnaire – Lymphedema
- Patient History Questionnaire – Occupational Therapy
- Patient History Questionnaire – Pelvic Health
- Patient History Questionnaire – Physical Therapy
- Patient History Questionnaire – Pulmonary Rehabilitation
- Patient History Questionnaire – Speech Therapy
What to bring and wear
- Comfortable, loose-fitting clothes are preferred but not necessary. Athletic footwear is also recommended for exercising in the gym area.
- If you are being evaluated for your lower extremities, shorts are recommended. We provide gowns if needed, however.
- For upper extremities, we recommend loose-fitting shirts, tank tops, V-neck T-shirts or button-downs.
- If you are being referred for pool therapy, your initial visit will not be in the pool. Your first visit will consist of an evaluation by a physical therapist to establish your baseline, obtain measurements, perform tests and work with you to determine your specific goals. Afterwards, we will show you where to go for your next visit, which will be in the pool. We provide towels, a locker room, bathroom and personal showers. We ask that you bring sandals to walk from the locker room to the pool, as well as any shampoo, conditioner and soap you may need to shower with.
- We have a water fountain in the main gym, but you are always welcome to bring your own water bottle.
- Wound care patients should wear comfortable, loose-fitting clothing to access the location of your wound.
How to get a referral and make an appointment
- Please contact your insurance company directly to see if it requires a provider referral for physical therapy, occupational, and/or speech therapy.
- If you need a physician’s referral but do not have a primary care provider, Northern Arizona Healthcare Provider Group’s excellent providers have direct communication with our clinics to provide you the most streamlined care.
- If you already have a referral or do not need one, please contact EntireCare today to make an appointment.