New Evaluation Form


Please complete forms from a LAPTOP or DESKTOP computer! Users with mobile browsers have reported errors with form completion and capture. Thank You!

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 ONLINE HERE or print off a hardcopy (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.

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.)



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.

Want The Hardcopy?

Download new patient paperwork.

Prefer to complete your paperwork the old fashion way? No problem. Just download this packet and bring the forms with you to your initial evaluation.