Office Information and Registration: Forms for New Patient Registration

Welcome to Florida Hospital Rehabilitation and Sports Medicine! Where the patient is our number one priority. We have a wide array of inpatient and outpatient programs, from neurological to pediatrics to audiology. Through a highly trained team of specialists, innovative technology and specifically designed treatment plans, the patient's individual performance goal is attained. We pride ourselves on the ease of referral process and our ability to see patients as quickly as possible. Our one-on-one patient to therapist care ensures the proper attention to detail.

The following forms are to be filled out by new patients to the Rehab center completed at your convenience prior to your evaluation. Download forms now for new patient registration. See below for details.

Patients Rights (All Patients)

Patient Rights and Responsibilities (English | Spanish)

Physical Therapy (PT) | Occupational Therapy (OT) | Speech Therapy (ST)

Adults: Ages 18 or older (2-4 Required Forms)

Outpatient History Form (English / Spanish)
Outpatient Medical History Form (English | Spanish)
Functional Status Questionnaire (Medicare Only)
Dizziness Questionnaire Form Vestibular Only (English | Spanish)

Peds: Ages 0-17 yrs (1 Required Form)

Outpatient Pediatric Case History Form (English | Spanish)

Audiology Services (3 Required Forms)

Outpatient Pediatric Case History Form (English | Spanish)
Audiology Adult Patient History Form
Scale of Auditory Behaviors (SAB) Form

Women's Health Services (1 Required Form)

Medical History Form