Patient Intake Form

Intake Paperwork: 

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All paperwork for Avant needs to be completed online. When you schedule your initial exam, our front office team will send you a link to your email, which contains our New Patient Paperwork. Paperwork must be completed in one sitting. It usually takes about 10 minutes to complete, but could take up to 30 minutes depending on the depth of your medical history. In addition to your medical history, you will need to read/sign/date our HIPAA policy as well as our Procedures and Financial Policy. 

  • Copy of your insurance card
  • Referral if relevant
  • Medications list
  • Prior medical history


As a part of the intake, you will be asked to fill out a Functional Outcome Measure based on how your injury affects your daily function. This is beneficial to help us track your changes over time in PT, but is also a requirement of some insurance companies. Please answer these questions relative to what “normal” would be for you. For example, if you will be seeing us for a shoulder injury, you will get an Outcome Measure called the Quick Dash. One of the questions you will be asked is “How hard is it to carry a shopping bag or briefcase?” While it may be tempting to answer “no difficulty” because you would just switch to your unaffected arm to carry the item, we would like you to answer relative to how difficult it would be to carry the shopping bag or briefcase in your affected arm. This helps us get a true idea of your function, not your ability to modify day to day tasks. 

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We make every effort to include your healthcare professionals and exercise specialists in a cohesive plan to promote your optimal outcome. We want to truly understand what drives you toward recovery.