Patient Info / Forms

We are here to help you enjoy your life, pain-free! To make a convenient appointment, simply call us today at 330-687-6891. Our practice is dedicated to helping you identify the cause of your pain and creating a custom treatment program that will allow you to return to normal activities pain-free.

Patient Forms

At Physio Balance & Sports Performance, we want to maximize your time with us. If you have access to a printer, please complete the following forms prior to your first visit.

PRIVACY STATEMENT Please note that no personal information from this form will be stored on our website database. All information is securely directed and saved in our clinic’s Electronic Medical Record (EMR) system where all data is encrypted. The patient information will only be used by the clinic and will not be passed on to any third party.

Credit Card Authorization Form

Dry Needling Consent Form

Patient Informed Consent Form

Photo/Video Consent & Release Form

Background Information/Medical History

Before Your First Visit

  • Make a list of questions that you have to discuss on your first visit.
  • List signs and symptoms that can be of importance to the therapist.
  • Have in writing key past medical history, previous treatments, current medications, and other important information.
  • Please call our office to verify your insurance benefits.
  • Arrive 15 minutes early for your first appointment.
  • Bring with you a copy of your insurance card and a photo ID.

What to Expect on Your First Visit

  • You will register with our friendly front office staff. They will help you navigate the insurance process and treatment program so you can focus on your recovery.
  • You will meet with your physical therapist for the initial evaluation.
  • During the evaluation, your therapist will ask questions about your medical history, current pain, or injury. Open communication helps us understand your problem.
  • Your movement, strength, coordination, and much more will be evaluated. Our purpose is to help you, so please ensure you communicate to your therapist if anything is hurting or bothering you during the examination.
  • Your therapist will recommend and prepare a course of treatments to ensure the quickest recovery and the best results. Your therapist will discuss the recommendations with you.
  • There will be some treatments performed the first day to get you started on your road to recovery. However, during the next visit you will get into the full swing of your treatment plan.
  • You will schedule your series of visits with the front desk. The amount of therapy needed will be discussed with you, depending on the recommendations of your therapist. We offer many convenient appointment times, however, prime times can become busy, so it is best to book ahead as much as possible.
  • Your therapist will write up their findings and treatment plan to submit to your referring physician or another medical professional who you choose.
  • If you have any questions at any time, Contact Us. We want to ensure your satisfaction and full recovery.