Orthopedic Physical Therapy of Northern Virginia

New Patient Intake Form

Print and Complete

Please download, read and sign the form below and bring it with you to your first appointment. You will need Adobe Reader to view this document online. It is a free program and you can download it here.

Patient Information Form

Dry Neeling Consent Form


About Dry Needling: Patients will need a prescription or signed/written consent from their doctor that says 'Dry Needling'. Patients will receive no more than 3-4 visits max unless the dry needling is showing significant improvements that indicates more sessions are needed. Patient's will need to fill out the form above and we will need to review it before scheduling an appointment.

PATIENT COMMENTS:

"The PT and Administrative staff are very caring and competent."

-- Louis M.