Patient forms
Click on the packet that is most appropriate for you, fill it out and send it to us before your first visit.
Choose your packet
Fill out and send the packet to intake@lorpt.com. Thank you, and we look forward to working with you.
Fax (949) 443-5463
- Back and balance packetFor back pain with balance problems.Download PDF
- Back packetFor back pain.Download PDF
- Balance packetFor balance problems.Download PDF
- Arm and leg packetFor problems in an arm and a leg.Download PDF
- Arm packetFor problems in an arm.Download PDF
- Leg packetFor problems in a leg.Download PDF
- Neck and back packetFor neck and back pain.Download PDF
- Neck and arm packetFor neck pain with arm symptoms.Download PDF
- Neck, back and arm packetFor neck, back and arm symptoms.Download PDF
- Neck packetFor neck pain.Download PDF
- Dizziness packetFor dizziness.Download PDF
- Leg and back packetFor leg and back symptoms.Download PDF
- Jaw packetFor jaw pain.Download PDF
Not sure which packet?
Call the clinic and we will tell you which one fits your problem. Whether your insurance plan needs a referral differs from plan to plan: call the number on your insurance card to check, or call us before your first visit and we will help you find out.