​Male:

Pelvic OROrthopedic Medical History

If participating in telehealth services,

this credit card form is required


​​*Add your credit card on file to be put on auto-charge!

​Female:

Pelvic OROrthopedic Medical History

If participating in telehealth services,

this credit card form is required.


*Add your credit card on file to be put on auto-charge!

​Our New Patient Forms:

Visit our "Contact Us" page for address and directions!

Please fill out the intake forms, and bring them with you to your appointment, or you can email a completed copy to lisenbypt@gmail.com. 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, do not forget to bring your photo ID and insurance card(s) that we will be billing.

*Effective 10/1/2019: Lisenby Physical Therapy for All will no longer be taking 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. Our receptionist and billing staff, at our main location, will be happy to assist you with these needs via automated payments, phone, or text.

Patients that have a co-pay plan with their insurance company or who have opted for our self-pay rate, we ask that you have a credit card on file with us so that we can charge your card at the time of service for each session. 


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

​For our pediatric patients:

Pelvic OROrthopedic Medical History

If participating in telehealth services, this credit card form is required


*Add your credit card on file to be put on auto-charge!