New Evaluation Form – CROSS ROADS

CROSS ROADS

Let’s Get Started!

We are excited to help you in your rehabilitation journey. Please complete the following 3 ITEMS prior to your first appointment.

  1. New Evaluation Paperwork (download below)
  2. Submit your INSURANCE & ID Cards using the uploader below.
  3. Review your patient privacy rights and make note of any questions you may have for our team when you arrive.

Evaluation Form

Download new patient paperwork.

Please download and complete this packet and bring the forms with you to your initial evaluation.

Thank You!

Official Documents

If you didn’t already, please upload a copy of your insurance card and driver’s license or official photo ID. (If you did already provide us these documents, you can disregard this entire section.)

THANK YOU! 

    Name*
    Email*

    Send request to this Velocity location:

    Attach Insurance Card:
    Attach Driver's License / ID:



    Almost Done!

    After you complete the multi-section  Patient Intake Form above, please send us a copy of your insurance card & driver’s license! Thanks a million!

    Patient Privacy Rights

    Click to view / download your patient privacy rights.

    Please contact us with any questions or concerns.  We are so grateful for the opportunity to provide you care.

    We are currently open and operating normally.

    Our staff is taking extra steps to ensure the cleanliness of the clinic space. You may notice some changes that we have implemented to protect our patients and staff.

    Currently, we are encouraging patients to stay home if you are not feeling well.

    Otherwise, we are here and ready to see you for your appointments. If you have any questions about your appointments, please reach out to us. CALL: 940-387-3700

    We are following the recommendations of the CDC and Denton County Health Department

    We have compiled a list of reliable resources of information about the Coronavirus for you.

    Coronavirus (COVID-19) Resources:

    CDC Coronavirus Task Force Website
    Denton County – COVID-19 Page
    City Of Denton COVID-19 Information
    Coronavirus Fact Sheet
    What To Do If You Are Sick
    How To Protect Yourself + STOP The Spread Of Germs
    Symptoms & Signs Of The Coronavirus

    Sincerely,

    Velocity Physical Therapy