Integrated Physical Therapy

(608) 658-5352

Fax: 1-888-965-4018

Contact Us:

Dee Aussprung


Dee Aussprung
Heather Hartwig Stokes
Kate LaZotte
Sarah Voung
Peggy Hojem



Evaluation Forms



Integrated Physical Therapy, LLC

Evaluation Forms

Patient Health History

Patient Information Form

Treatment Agreement

Privacy Notice Form

Insurance Verification

Required For All UHC Patient's


These forms can be printed and filled out in advance for your convenience. This will enhance your evaluation, and allow for more treatment time on your first visit. When scheduling, please ask which forms to fill out. Thank You!



2275 Deming Way Suite B 100 Middleton, WI 53562