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To expedite the paperwork
process, please print out and complete the following forms before you arrive
for your first therapy appointment. Contact our office at (866) 588-0230 if you
have any questions.
In order to download these forms, you must have
Acrobat Reader on your computer.
To download the FREE Reader, follow
these simple instructions:
- Go to
Acrobat Reader's
download page. You cannot get the application without Acrobat
Reader.
- When you have
completed the simple download and have installed Acrobat Reader on your
computer (it'll only take minutes), come back to this page.
Patient Registration Form
Privacy Notice Form
Medical History
Let us
know how well we served you. Please print out and complete the following survey
after you’ve been discharged from active therapy care
Patient Satisfaction
Survey
Completed surveys should be mailed to:
WSR&F
308 SE 9th Street
Pella, Iowa 50219
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Get well!
Stay well!
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