Synergy Fitness Programs 
For Patients > Forms
Patient Medical history (PDF download)
The Patient Medical History form describes your basic medical history.
Patient Intake Form (PDF download)
For new Dee PT patients to complete prior to their first visit.
Physical Therapy Attendence Policy (PDF download)
Dee Physical Therapy strives to provide each patient with the highest quality of care while attempting to accommodate your schedule for your convenience. Therefore, we provide reserved time slots for each patient in order to minimize waiting time and assure continuity of treatment. Your consistent attendance of the planned treatment regimen is paramount to your full recovery.
Medicare Questionare (PDF download)
This form be completed by Medicare patients per Medicare guidelines.
Social Service Questionare (PDF download)
A social worker is available to you while you are treating at our facility. The social
worker is able to provide you with referrals to community resources, transportation
issues, assistance at home, or counseling. Would you like to talk with a social worker?
The forms above require the free Adobe Reader application.
