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	12581 Milstead Way, Suite 201 Woodbridge, VA 22192



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Express Patient Registration

We make it easy for you to register for care by having you complete a minimum amount of paperwork. Please complete and bring the following forms with you on your first visit.

1. Express registration form

2. Pre-exam form

3. Pre-exam form - Post op patients

4. Medicare secondary payer questionnaire (medicare patients only)

5. Assignment of benefits form

6. Consent for treatment form

7. Pain diagram form

Mid-County Physical Therapy - 12581 Milstead Way, Suite 201, Woodbridge, VA 22192