Intake Form

» Intake Form

FYZICAL Holland looks forward to having you join our host of satisfied clients, welcoming you to our state-of-the-art facility, and providing you with excellent physical therapy.

Once you have made your initial appointment, 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.

Downloadable Forms:

Patient Information Form

People Involved in Patient Care Form

Financial Policy


Non-Parent/ Guardian Form (FOR 16 YEAR OLDS AND YOUNGER)