Print and complete these forms on your time. You can either fax or email the forms and your doctor’s referral to FYZICAL of Jacksonville prior to your first visit, or you can bring them with you to your first visit.
Fax number: (904) 223-2365
All New Patients: please select, print and fill out both of the following forms:
Please select, print and fill out one of the following pain questionnaires:
(If you are being treated for difficulty with walking or balance, please fill out the leg pain questionnaire. Your therapist will then review the questionnaire and possibly do further testing during your evaluation.)
United Healthcare Patients: please select, print and fill out the following form:
Patients who are Minors (under 18 years old): Parent/Guardian please select, print and fill out the following form:
Additional Forms, Notice of Privacy Practices, Adobe Reader Download: