New Patient Intake Form
To save time before your initial evaluation, you can fill out this form after downloading it. On the first page, please print your name as spelled on the insurance card, DOB, phone number, address, the body part to be treated, and insurance information. On the second page, please fill out the medical history form. On the third page, please sign our waiver of liability and cancellation policy.
Injury Prevention Screen Form
Print and complete the attached form before your injury prevention screen. You can bring the form with you to your appointment, or fax it to one of our offices.
Rehoboth Fax: (302) 226-2692
Wilmington Fax: (302) 477-1564
Hockessin Fax: (302) 234-1032
Elite PT is now recognized by Complete Concussion Management Inc. (CCMI) and joins a network of clinics around the world offering evidence-based concussion care. From initial pre-season multimodal baseline testing to concussion treatment and rehabilitation, our partnered CCMI practitioners collaborate with primary care physicians to co-manage concussions, helping patients and athletes safely Return to Learn, Work and Play. Click on the download for a PDF with complete information.