Patient Paperwork

Patient Intake Forms

At Franklin Rehab, we want to maximize your time with us. Prior to your first visit, you may download and print the applicable form or fill out new evaluation forms online.

Medicare & Self Pay Program

New Evaluation Form - English

Nueva Cita - Español

Pelvic Floor Therapy Questionnaire:

When Was Your Appointment?

We recently changed bill pay providers. Please click the button for the date of your appointment to be directed to the correct online payment portal.