Intake Form

» Intake Form :

FYZICAL Granger, IN 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 in Granger, IN. To schedule an appointment, please call us at (574) 271-8424.

Once you have made your initial appointment, you may pre-register online by completing the interactive forms below, or you may download and print the forms, fill them out and bring them with you to your first visit. Completing the forms prior to your visit will help speed up the registration process.


Commercial and Self Pay Patients:

Commercial Intake Packet

Medicare Patients

Medicare Intake Packet

Balance Paperwork

Dizziness Handicap Inventory

ABC Scale

Dizziness Symptoms Scale

Independent Assessment

Concussion, Head Injury, and Cranial Pain

Sport Concussion Assessment

Migraine Disability Assessment

Headache Disability Index

TMD Index

Pelvic Health 

Overactive Bladder - OABSS

Pelvic Floor Distress Inventory


Chronic Prostatitis Symptom Index - Male

Leg Pain Paperwork

LEFS Form for Hip, Knee, Ankle, and Leg Pain

Foot and Ankle Disability Index

Oxford Hip Assessment

Tegner Lysholm Knee Assessment

Neck and Back Pain

Modified Oswestry Back Pain

Neck Disability Index

Arm and Shoulder Pain

Quick Dash Arm and Shoulder