Intake Form

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» Intake Form :

FYZICAL Chastain looks forward to having you join our host of satisfied clients. Without you there can be no triumph. Because physical therapy without the client is intent without involvement. However inspired, it is like rain without water, only a hope. Because you Love Your Life, your independence, your day…we exist.

We look forward to welcoming you to our state-of-the-art facility and providing you the best physical therapy.

Once you have contacted our facility, a member of our staff will reach out to you to schedule for initial evaluation and collect some basic information. From this point, you will have the option to recieve further intake paperwork via email or text to be completed online. 

If you prefer to not complete this paperwork online, downloadable copies are made available here to you. Simply click on the link, save the document, and provide the necessary information. You may then email completed documents to chastain@fyzical.com or print and bring them to your initial evaluation. 

Completing the forms prior to your visit will help speed up the registration process.


Required Forms:

New Patient Registration

New Patient Medical History

Patient Acknowledgement Form

Cancelation Policy

Optional Forms:

Direct Access Notice

Notice of Privacy Practices:

Notice of Privacy Practices