Intake Form

» Intake Form


We are so glad you chose the FYZICAL Therapy & Balance Center of Germantown to serve your physical therapy needs. Prior to your first visit, you will be asked to fill out a series of forms listed below so we may better serve you. Please click on the links below to view, print, and fill out the forms prior to your first visit. You can also fill them out in the office but please arrive 10-15 minutes prior to your appointment time to do so. 

Cancellation Policy

When unable to make a scheduled appointment, please call 24 hours in advance to cancel the appointment. FYZICAL of Germantown reserves the right to charge a $75 fee for appointments missed without a 24 hour notice. Payment for this fee is the responsibility of the patient and will not be covered by insurance.