Patient Information

Patient Forms

View/print our Patient Registration Packet in advance to help with your registration and visits at Xcel Sports Medicine.

Instructions:

Complete all sections as appropriate.  If the patient is under 18 years of age, a parent or guardian is responsible for signing the consent for treatment sections.

The following Registration Packet consists of:

  1. Patient Registration – Basic patient demographic information.
  2. Insurance Information – List your primary and secondary insurers as well as the guarantor demographic information as indicated on your insurance card.
  3. Medical History and Medication Listing – You may attach a copy of your medication list if it is already in written form.
  4. Patient Acknowledgment of Receipt of Notice of Privacy Practices and Consent/Limited Authorization & Release Form – Please complete in its entirety.  The Notice of Privacy Practices is available for your review on this website, in our lobbies or upon request from any of our Receptionists.
  5. Notice of patient Appointment and Billing Practices – For your review
  6. Surviving Physical Therapy – What to expect from Physical Therapy at Xcel.

HIPAA Notice of Privacy Practices

This notice is available for information purposes.  Please review online.  You do not need to print with your registration packet.