Forms and downloads
Print, sign, and bring these to your visit, or complete them in your secure client portal. Please do not email completed forms, since they contain personal information.
Client forms
Authorization to Release Home Safety Report
Lets you name the family members, caregivers, or professionals who may receive your report. You can revoke it at any time.
Contractor Consultation Service Order and Modification Prescription
Names the contractor you chose and authorizes us to send them your Modification Prescription. The prescription contains no health information.
Guides you can print
Home Video Walkthrough Guide
How to prepare the home and your phone for a Ready for Discharge video session, with the measurements we will ask for.
Storm Ready checklist
Hurricane, heat, and power-outage preparation for households with medical equipment.
Fall risk quick check
Twelve yes or no statements adapted from the CDC's Stay Independent brochure. Your answers stay on your device.
Forms we send through the secure portal
These are completed online after you book, because they involve health information:
- Telehealth consent for video sessions
- Authorization to request therapy notes from a hospital or facility
- Client service agreement, with a notice for people who have Medicare