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For New Patients

Now offering a new quick and efficient way of gathering information through our patient portal!  

The patient portal is a seamless tool that lets our patients fill out all of their basic information and health history on one online form. When scheduling your physical therapy visit, make sure to provide us with your email address where we are able to send you a link to start your online registration prior to coming in for your first appointment. This way you don't have to deal with the hassle of printing off and filling out sensitive information on a piece of paper. During this transition period, if you ever have any trouble with the patient portal do not hesitate to give us a call at 402-939-7939 (Maple/UBA) or 402-763-8774 (Pacific), and one of our trained front desk staff will run you through any problems that may occur. If you are still having some troubles, you may always print and fill out the forms located below and bring them with you to your first appointment.  

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 Street (2728 N. 108th 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) 939-7940
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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