Chanhassen   952-448-9081
Eden Prairie   952-873-7400
Minnetonka   952-512-2400 Chaska   952-512-2470

Your Initial Evaluation

 

We suggest that you arrive 10-15 minutes before your appointment. There will be some paperwork to complete for both new and previous patients. Each of our locations provides convenient and secure locker storage for your personal belongings during your treatment.

Please bring to your Initial Evaluation:

  • Any Previously Completed Intake Paperwork (Found Below)
  • Your Health Insurance Identification Card
  • Your Drivers License/Identification Card
  • Any Physician Orders or Insurance Referrals
  • Any Physician’s Notes That Were Provided to You
  • Yourself!!!

As a courtesy to all of our patients, we have posted all of our intake forms online! Feel free to download and complete these forms to bring with to your Initial Evaluation!

(If patient is under 18 years of age, please have parent/guardian sign all intake forms)

  1. Patient demographic form
  2. Patient History (Non-Medicare)   ~OR~   Patient History (Medicare)
  3. HIPAA Notice of Privacy Practices (Outlines OSR’s HIPAA Compliance Policies)
  4. HIPAA Notice of Privacy Practices Acknowledgment (Acknowledgement of OSR’s HIPAA Policies)
  5. Attendance and Financial Policy
  6. Consent for Treatment of Minors  (Please Complete if Patient is Under 18 Years of Age)
  7. Release of Information to Athlete Coach (Authorizes OSR Providers to communicate information pertaining to your son/daughter’s rehabilitation to their coach)

 Non-Physical Therapy Intake Forms

Fitness:

Fitness Programs Intake

  • Fitness Programs Intake is used for all cash-pay programs, including: Personal Training, , Anti-gravity (Alter G) training, Aftercare, and Running Analysis

BikeFit:

Bike Fit Intake