877.776.9843

New Patient Packet

All new patients are asked to fill out a Medical History Form, a Patient Registration Form and a Missed Appointment Policy Form. These forms are available for you to download if you wish to complete them prior to arriving at ProEx Physical Therapy. If you are unable to fill out these forms ahead of time, our Front Desk Specialists will be happy to assist you when you arrive.



Job Demands Questionnare

The key to a safe return to work after an injury is with the physical therapist fully understanding your job demands. Please take a few minutes of your time to fill out this form and bring it to your physical therapist. It will be a tremendous help to your PT.



Golf Fitness Registration Form

ProEx Physical Therapy offers a PROfitness golf program for golfers interested in improving their game by maximizing their physical capacity. Golfers will meet with Physical Therapists trained in the biomechanics of the golf swing. If you are interested in increasing your golf performance, please fill out the attached form and contact one of our clinics. Please note, these fitness services are not covered under healthcare insurance.



Patient Satisfaction Form

Your opinion is important to us. We want to know about your experience with ProEx Physical Therapy. We strive for excellence in everything that we do and we rely on your feedback and suggestions to help us maintain the highest level of patient care. Please take a minute to fill out our Patient Survey. You can return it to the clinic or email it to us at info@proexpt.com.



Wilmington Medical History and Permission Form

ProEx Physical Therapy contracts Athletic Training Services to various sports organizations throughout New England. In order to deliver the best care for our athletes it is important that our Certified Athletic Trainers are given the proper medical history information about their athletes so please make sure to fill out the medical history from for your school and return it to your athletic trainer. Also of note, all athletes are required to have updated physicals to participate in high school athletics. If you have any questions in regards to the medical history form for high school athletes, please contact the ProEx Physical Therapy head Athletic Trainer assigned to your high school.



Woburn HS Student Athlete Medical History Form

ProEx Physical Therapy contracts Athletic Training Services to various sports organizations throughout New England. In order to deliver the best care for our athletes it is important that our Certified Athletic Trainers are given the proper medical history information about their athletes so please make sure to fill out the medical history from for your school and return it to your athletic trainer. Also of note, all athletes are required to have updated physicals to participate in high school athletics. If you have any questions in regards to the medical history form for high school athletes, please contact the ProEx Physical Therapy head Athletic Trainer assigned to your high school.





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Patient Privacy

At ProEx Physical Therapy, we place the highest priority on a patient’s right to privacy. We are committed to providing you and your family with exceptional care and forming a relationship that is built on trust. This means that we respect your right to privacy and will endeavor to protect the confidentiality of you and your family's health information–whether this information is stored in a paper or electronic file. ProEx adheres to the requirements outlined by the Health Insurance Portability and Accountability Act of 1996 (HIPAA), as well as applicable State’s General Laws, which ensure the privacy and security of an individual’s health information and promotes privacy and trust between patients and their health care providers. We have detailed policies and procedures in place to safeguard your rights to privacy and confidentiality.  Our Compliance Officers can also provide information on how we protect your health information and how you may request you/your minor child’s health information. As part of HIPAA requirements, all new patients seeing their health care provider, upon their initial visits, are required to sign the Acknowledgement of Receipt of Privacy Notice form to indicate that they have received the Notice of Privacy Practices. Our Notice of Privacy Practices describes how we may use or disclose your health information; your rights to access your health information and/or to request changes to your health information. You may also request a list of people or organizations that you did not authorize but who may have received your health information from us.

Click here to Download our Notice of Privacy Practices.