Forms for Evaluation

…you will then receive electronic documents from Hellonote on behalf of Mobile Physio. Please complete these forms prior to your evaluation. However, if you have trouble completing them electronically, feel free to download and print the paperwork directly from this page, complete the 6 forms (see below), and we will gather the forms on the day of your evaluation. Leave blank any sections you have questions about and we will gladly answer questions on the day of the evaluation.

If you cannot receive the electronic paperwork from Hellonote, and you also cannot print, don’t worry! We can bring paper copies to the evaluations and will help you at that time. If you are able to print and want to get a head-start, the 6 forms we will need are below:

1) Notice of Privacy Practices, Financial Policy, and Consent for Treatment
(Please review this document in its entirety, but we only need you to print and complete the first page)

2) HIPAA Release Form

3) Disclosure of Financial Ownership or Interest Form

4) AI Consent

5) No Surprise Billing Form

6) Attendance Policy