Patient Information at Clay County Physical Therapy

Before Your Visit Before your visit with Clay County Physical Therapy, download and fill out the following forms, as instructed by your therapy team, and bring them completed to your appointment. If you have Medicare Part B insurance, please also have a list of your current medications with you at your appointment. if you have any questions about these forms or your visit, please call us at 402-773-0270.
Patient Intake Form	Patient Summary Form (UHC)	STarT Back Form (UHC Back)

Before Your Visit

Before your visit with Clay County Physical Therapy, download and fill out the following forms, as instructed by your therapy team, and bring them completed to your appointment. If you have Medicare Part B insurance, please also have a list of your current medications with you at your appointment. if you have any questions about these forms or your visit, please call us at 402-773-0270.

Patient Intake Form

Patient Summary Form (UHC)

STarT Back Form (UHC Back)

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