Patient Forms

At CT Physical Therapy Care, we value your time and convenience. Before your first visit, you may click the link Online Intake Form to register in our database. We will then reach out for your appointment.

Online Intake Form

For a quick registration, please print and fill-up the forms applicable for you. Bring them on your first visit along with your insurance information and photo ID.

FOR ALL INSURANCES & CASH

• Patient Consent
• Patient Registration Form

ADDITIONAL FOR WORKERS’ COMPENSATION

• Workers’ Compensation C3 Form
• Workers’ Compensation A9 Form
• Workers’ Compensation OC-110A
• HIPAA OCA Form 960
• Lien Form

ADDITIONAL FOR NO-FAULT CASES

• No-Fault Assignment of Benefits
• No-Fault NF3 Form
• HIPAA OCA Form 960
• Lien Form

If you need assistance, please call 718-255-6229 on Mondays to Fridays from 9 am to 7 pm.