For your convenience the following forms are available for you to review or complete:
New Patient Forms
- Patient History Form
- FMLA/Disability
- Medical Records Release Form
- Medical Records Release Form – Dr. Lou Patients – Southside Regional Medical Center
- Notice of Privacy Practices
General Forms
Women’s Health Physical Therapy Forms
- Physical Therapy New Patient History Form
- Female Pelvic Floor Intake Questionnaire
- Bladder Symptom Questionnaire
- What to Expect at First Physical Therapy Visit