What to Bring to Your Appointment

Before your first visit with a physical therapist or medical program instructor, please download, print and complete the forms provided below. Please bring the completed forms to your scheduled appointment as well as your insurance card. If you have a list of medication, you may want to make a copy of that list and bring it with you.

Please wear comfortable clothing that you can easily move in. Don’t forget to bring your planner so we can make future visits.

If you are being seen in Aquatic Therapy, bring your swim suit in case there is enough time after your initial evaluation to get in the pool. 

Please check the following list for precautions and contraindications for aquatic therapy:

Precautions

Uncontrolled hypertension/hypotension

Diminished respiratory capacity

Recent radiation treatment (last 3 months)

Contraindications

Severe hypotension

Epilepsy

Fever higher than 100 F

Bladder or vaginal infections

Infectious diseases

Open wounds

Known allergies to pool chemicals

Bowel or bladder incontinence

PLEASE USE BLACK INK WHEN FILLING OUT THE FORMS:  Patient Forms (download here)

YMCA Healthy Living Center Medical Office ~ (P) 515-645-3350 ~ (F) 515-224-2907