Intake Form

» Intake Form

Fyzical Therapy & Balance Centers of Sarasota, FL 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 Sarasota, Florida. To schedule an appointment, please call us at (941) 951-0170.

Once you have made your initial appointment, you may download and print the forms below, and bring them with you to your first visit. Completing the forms prior to your visit will help speed up the registration process. 

If you provide us with your email prior to your registered first visit, you will automatically receive a link that enables you to fill out patient registration forms online. If you choose this option, you don't need to print and fill out the Medical Questionnaire as shown in link below under Downloadable Forms. 

Downloadable Forms:

Medication List

Patient Demographics

Patient Acknowledgement Form

Medical Questionnaire


Spanish Intake Forms

Fall Risk Assesment

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