Forms | BE Fit Physical Therapy

All patients need to fill out the following new patient paperwork before we can begin your first appointment. For your convenience, we’ve updated our forms so that you can fill them out within Adobe Acrobat.

1. Download the form
2. Open it with Adobe Acrobat
3. Fill out and save it
4. Submit it via email to: info@befit-pt.com

• Telemedicine—Consent For Treatment and Billing for Services
• In-person Visits—Consent For Treatment and Billing for Services
• HIPAA Notice
• Medical History for New Patients
• Medical History for Returning Patients

Additional forms you may need to fill out if you are being seen for:

• Your Back
• Your Neck
• Your Shoulder, Arm or Wrist
• Your Hip, Knee or Ankle

If you are covered by the Dartmouth Student Group Health Plan (DSGHP – HealthSmart) through Dartmouth College please complete the attached form and review the expected out-of-pocket coverage information here.

(Updated May 2023)