Forms

For New Patients

What to Bring Along on the First Day of Physical Therapy:

PLEASE NOTE:  Pop-Up blockers sometimes make printing these forms impossible
...Turning off your pop-up blocker for www.PTomaha.com might solve this problem.

1) BOTH completed registration forms--> 

(Click the name of the form in blue text at the right
to download forms.  Then print & complete.)

          Registration Forms:
(A) Patient Information Form
(B) Medical History Form

2) Your physical therapy prescription (From your doctor)
3) Your insurance card

(For Workers' Compensation, bring your claim number
and your case manager's contact information. )

4) Photo ID

Typically a driver's license or military ID


What if I can't print my paperwork at home?

No problem, you can fill it out at the clinic - BUT - you'll need to arrive 30 minutes prior to your scheduled time, so that the paperwork doesn't cut into the time that your therapist has reserved for you.

If I'm bringing my paperwork along, already completed, why do I still need to come 15 minutes early?

You still need about 15 minutes on the first day to meet briefly with our front desk staff, finalize paperwork, and review insurance benefits as needed. This is VERY IMPORTANT, as your therapist has time blocked out on their schedule especially for you, starting at your appointment time.  If you haven't gotten the paperwork and insurance business completed beforehand, it could cut into the time that your therapist has available for you. 

My forms are complete, but I'm worried that I will forget to bring them - may I email them to you?

No.  ***Due to security/privacy issues with email, please do not send completed documents by email, as they contain  sensitive personal data***.  HOWEVER ...

Printed forms MAY be fax'ed ahead of time to your treatment location:

  • For Maple Village (10118 Maple St.), fax to:  (402) 939-7940
  • For Pacific Village (7611 Pacific St.), fax to:  (402) 715-5742
  • For UBA (inside Ultimate Baseball Academy), fax to:  (402) 884-5088
IF you are being seen by Jodi Reerink, PT for pelvic pain, incontinence, or other pelvic floor related problems), then this form should be completed in addition to the regular forms noted above:
Pelvic Floor History and Information Form

We look forward to seeing you!

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