(847) 459 4779
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  • About Us
    • Who We Are
    • Meet the Team
    • PDR Gives Back
    • Photo Gallery
  • What We Treat
    • Back and Neck Disorders
    • Chronic Pain
    • Complex regional pain syndrome (CRPS)
    • Headaches and TMJ Problems
    • Orthopedic and Posture Issues
    • Parkinson, Vertigo and Balance Problems
    • Pelvic Floor
    • Pre and Post Surgical Problems
    • Sports Injuries
    • Work and Auto Injuries
  • How We Treat
    • Physical Therapy
    • Manual Therapy
    • Good Posture Academy
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    • Gymnastics Classes for Children and Youth
    • Ocean Breeze Massage Center
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    • FAQs
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    • Direct Access to Physical Therapy in Illinois
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  • Contact Us
Make a Payment
  • English
  • Polish

Make a Payment
  • About Us
    • Who We Are
    • Meet the Team
    • PDR Gives Back
    • Photo Gallery
  • What We Treat
    • Back and Neck Disorders
    • Chronic Pain
    • Complex regional pain syndrome (CRPS)
    • Headaches and TMJ Problems
    • Orthopedic and Posture Issues
    • Parkinson, Vertigo and Balance Problems
    • Pelvic Floor
    • Pre and Post Surgical Problems
    • Sports Injuries
    • Work and Auto Injuries
  • How We Treat
    • Physical Therapy
    • Manual Therapy
    • Good Posture Academy
  • Wellness
    • Gymnastics Classes for Children and Youth
    • Ocean Breeze Massage Center
    • Wellness Center
  • Patient Portal
    • FAQs
    • Insurance Information
    • Patients’ Forms
    • Direct Access to Physical Therapy in Illinois
  • News and Insights
    • Promotions
    • Health Tips
    • Events
    • Blog
  • Contact Us

Patients’ Forms

  • Direct Access to Physical Therapy in Illinois
  • FAQs
  • Insurance Information
  • Patients’ Forms

PATIENTS’ FORMS

The link below will provide you with our patient forms. Please print these out, complete them, and bring them with you when you come in for your first visit.

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Patient Form (EN)

Download
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Patient Form (PL)

Download
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HIPAA Notice of Privacy

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Minor Health & Fitness Liability Waiver

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In case of main phone line technical issues call

(847) 523 6404

Contact

Phone:
(847) 459 4779

Fax:
(847) 459-5771

Location:
920 E. Northwest Highway Mount Prospect, IL

Email: pdrehab@PDRehab.com

Our Blog

  • Plantar Fasciitis
  • Back Pain
  • School Supply and Backpack Drive
  • Alternative therapies for Parkinson’s disease
  • Life with CRPS

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