Patient Forms

Thank you for choosing Confluent PT! We look forward to working with you. For your convenience, we’ve provided our patient forms below.

Thank you for choosing Physical Therapy at Walmart Health! We look forward to working with you. For your convenience, we’re providing our patient forms below. To help expedite your first visit, please download, print and complete the applicable forms and bring them with you for your first visit. If you choose to fill out the packet in office, please arrive 15 minutes early to allow enough time to complete the forms before your scheduled appointment time.

• Consent for Treatment
• Authorization for Use/Disclosure of Protected Health information
• Medical History
• Patient Information Sheet
• Medicare Part B Beneficiary Notice of Therapy Limits
• Medicare Secondary Payer Form

Additionally, our notices are available for review below:

• Notice of Privacy Practices