Copyright © 2008-2010  Nichols Therapy Group, PC   Star, Idaho, USA   All Rights Reserved  
Web Hosting BigWestInternet.com
Big West Web Design
FORMS
What to Bring to Your Appointment
1. Insurance Card / Billing Information
2. Doctor’s Prescription (if applicable)
3. Downloaded Forms (completed)
4. Please wear, or bring, comfortable or loose-
    fitting clothes which will allow the therapist
    to evaluate the area. T-shirt, shorts, sweats
    are recommended.
Printer Friendly Patient Forms
Patient Information Form
Consent for Treatment & Financial Agreement
HIPAA Notice of Privacy Practices
Physician Referral Form
QUALITY CARE
YOU DESERVE
 Phone 208.286.0766