In order to expedite your treatment, please take the time to fill out the patient information form below prior to your first visit. It is strongly recommended that you print out the forms and bring them with you on your first visit. It is possible to upload the information using the contact form below, but note that any information sent through email channels is not transmitted securely.
Note: For Functional Dry Needling, please also print, read and sign the Needling Consent Form.
How to Submit the Patient Information Form
If you plan to mail or fax it:
1. Click on the form link here.
2. Complete the form on your computer.
3. Once the form is completed, print the form.
4. Mail (PhysioDC, 1001 Connecticut Avenue NW, Suite 330, Washington, DC 20036) or fax (202-379-9299)
If you plan to email it:
1. Download the form from here.
2. Complete the form in Adobe Acrobat.
3. Save the completed form to your desktop. Important: Please save the pdf as a file named “FirstNameLastName.pdf” (e.g. “JoeSmith.pdf”), with no spaces or punctuation.
3. Upload the completed form through the online contact form (see link below).
(Some computers may have difficulty saving the completed form. If you have difficulty saving the completed form, please print off the completed form and then either scan/upload it or fax/mail it).
Note: If you prefer not to submit the form in advance, you may bring the completed form with you to your appointment.