Patient Forms & Registration

You can save time on your first visit by completing your paperwork today.

At CT Physical Therapy Care, we value your time. To ensure your appointment starts exactly when scheduled, we ask that you complete your registration before you arrive. This gives our team time to verify your insurance benefits and prepare for your evaluation.

Please choose the option that is most convenient for you.

Option 1: Online Registration (Recommended)

This is the fastest and easiest way to register. You can fill out your information securely from your phone or computer, and it goes directly into our system.

[>> Click Here to Fill Out the Online Intake Form]

Option 2: Printable PDF Forms

If you prefer to fill out paper forms, please print and complete the documents below.

• Important: Please bring your completed forms, your Photo ID, and your Insurance Card to the front desk when you arrive.

For All Patients (Standard Form)

Everyone must complete these two forms:

• Patient Consent Form
• Patient Registration Form

For Workers’ Compensation Cases

If you were injured at work, please also add these forms:

• C-3 Employee Claim Form
• Form A-9 (Notice of Responsibility)
• Form OC-110A (Authorization)
• HIPAA OCA Form 960
• Lien Form

For No-Fault (Car Accident) Cases

If you were injured in a vehicle accident, please also add these forms:

• Assignment of Benefits Form
• NF-3 Form (Verification of Treatment)
• HIPAA OCA Form 960
• Lien Form

Need Help?

If you aren’t sure which forms you need or have trouble accessing them, please don’t hesitate to call us. We can guide you through it or provide the forms when you arrive (just be sure to arrive 15 minutes early!).

What else do you think I should bring? [See the full Pre-Visit Checklist here.]

Call for assistance: 718-255-6229