Please fill out one of the secure forms below that best fits your reason for physical therapy care. 

Female Patients

Male Patients

Pediatric Patients


for Pelvic Health conditions such as Incontinence, Post-partum conditions, Pelvic Pain, Pain with Intercourse, or Prolapse.


​for Orthopedic conditions such as Back or Neck Pain, Dizziness and Balance Disorders, Pregnancy, or Joint or Muscle Pain.


for Pelvic Health conditions such as Chronic Prostatitis, Incontinence, Post-Prostatectomy Pain, or Interstitial Cystitis.


for Orthopedic conditions such as Back or Neck

Pain, Dizziness and Balance Disorders, or Joint or Muscle Pain.

Medical History;

for all Pediatric health conditions such as ​Bed Wetting, General Orthopedic Pain/Strains, Constipation, Bladder Conditions, Postural Abnormalities, Sports Injuries.

​New Patient Forms

Inside Natural Balance Wellness Center: 719 Lake Avenue, Peoria, IL 61614

Phone:309-839-8631        Fax: 855-579-3536        Text: 309-253-1306        Billing: 309-256-8312

​​​​Lisenby Physical Therapy for All does not take onsite payments via check, card, or cash. 

We want our therapists to be able to focus on your care and not use vital treatment time to complete these types of tasks. Please fill out the above applicable form. Our receptionist and billing staff, at our main location, will be happy to assist you with any questions or needs you may have.

​We do apologize for any inconvenience this may cause but are confident this gives our therapists more time to focus on your care! 

Please fill out these forms prior to your appointment. If you are unable to complete these forms beforehand, please come 15 minutes early to complete them in office, before your appointment. Failure to do so, may result in an incomplete initial exam and delay your treatment progression.

Also, please bring your photo ID and insurance card(s) that we will be billing to your appointment.

Lisenby Physical Therapy for All