Prepare for Your First Visit to Millennium Rehabilitation
Make your first visit at Millennium Rehabilitation run as smoothly as possible; please bring the following documents and forms regarding your background and medical history:
- Insurance ID Card
- Drivers license or State Photo ID
- PT order (if provided by your physician)
- List of Medications (if applicable)
REQUIRED FORMS – click to download and print the following forms for your visit:
Demographic Form
Health Questionnaire
Patient Acknowledgement
ADDITIONAL OPTIONAL FORMS – In order to get a good understanding of your pain and/or symptoms, please fill out the form/forms below that coincide with the area of the body your pain/symptoms are involved with:
Neck Index
Back Index
Lower Extremity Function Scale
DASH (Arm, Shoulder, Hand)