patient forms 

After scheduling your appointment, please complete each form, print out and bring with you on your appointment day. 

All patients must fill these forms below:

*For medicare patients only.

Additional forms may be needed: 

A direct access form is needed if you do not have a Doctors prescription upon your first visit.

*For medicare patients only.

An advanced beneficiary notice is needed if you use Medicare but do not decide to submit your Physical Therapy bill to Medicare. 

You can fill this form out at your initial visit. 

contact us

To inquire about our Physical Therapy, wellness services, classes or our career advancement opportunities please call us or use the form below to request more information to see how we can meet your needs. 

visit us

Monday - Friday

8:00 AM - 8:00 PM

Tel. 212-541-8450/212 - 541 - 1606

Fax. 212-541-8582

53 Columbus Ave

Suite 4 

New York, NY 10023

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© 2018 by WESTSIDE DANCE PHYSICAL THERAPY.