Medical Forms

To streamline the process as a new patient, fill out the following forms that pertain to you. Please print and have them ready for your first appointment. All patients must complete the Pain & Symptoms form, plus the form(s) pertaining to your specific condition(s).

If you have any questions about these forms, please call Karen at 310-385-9064 or send an e-mail to karenjoubertpt@gmail.com.

ALL PATIENTS — Please click links to download:
Complete these form(s):
• Self-Pay Intake & Agreement
• Pain & Symptoms

AND

Depending on your condition(s) or needs, complete the following form(s):
• Neck Pain
• Low Back Pain
• Shoulder Pain
• Upper Extremity (Neck and Back; Wrist, Hand and Elbow)
• Lower Extremity (Hip; Knee; Foot and Ankle)
• Blood Flow Restriction (BFR) treatment

Privacy Practices
Notice of Privacy Practices is available through this link.

Forms require Adobe Reader, a free download from the Adobe website.
 

Frequently Asked Questions (FAQs)

Do you accept insurance?
Cash only for House Calls and Telehealth sessions. We accept Venmo, Cash App, PayPal or credit cards. Super-bills will be provided upon request for insurance submission; however, these are not a guarantee for reimbursement. Please contact your provider. Treatment or consultation is provided on a self-pay basis only and is due at time of service. Please download the Patient Intake Form for more details.

What is your appointment cancellation policy?
Missed appointments or appointments cancelled under 24 hours from the scheduled appointment time will be at charged 50% of the established House Call rate.

What do you need for my first appointment?
Please print out and have your completed medical forms ready (follow the links above), along with your current PT order and photo ID.

What should I wear for physical therapy?
You should dress comfortably in loose-fitting clothing for your House Call appointment. I ask my patients to please refrain from using perfume or strong fragrances. Thank you.

Do you offer same-day appointments?
If you have sustained a sudden injury, I will make every effort to treat you the same day.

What specific injuries or pain do you treat?
Knee or back pain, ankle sprains, rotator cuff injuries, shoulder pain, neck pain, pre- and post-partum pain, pre- and post-operative pain, posture stabilization and migraine headaches. Please visit the Treatment Options page for more in-depth information, or give me a call at 310-385-9064.

Do you stock physical therapy or medical products for purchase?
Yes, I can provide high-quality products such as Silagen silicone gel for scar reduction, SuperFeet insoles, Kinesio tape, Therabands, Bauerfeind braces for all joints and BioFreeze. Please ask if there is a specific item that you need.