​​​​Outpatient Rehabilitation Patient Forms​

​Outpatient rehabilitation patients or their legal guardians will be asked to complete and sign the required forms prior to treatment. Click on the following links to download and print the pdf forms. 

• ​Registration
• Cancellation Policy
• Medical History​
• HIPPA Authorization​
• Medical ​​Information Release Authorization​
• Authorization for Appealing Insurance Denials​​

Completed forms should be emailed to ksimpson@floyd.org or faxed to 706-292-7209 at least 24 hours prior to the appointment. For additional questions, please call 706-509-3400.​