Patient Info / Forms

We are here to help you enjoy your life, pain-free! To make a convenient appointment, simply call us today at (818) 953-4444 or click here to request an appointment. PerformaX elite is dedicated to helping you identify the cause of your pain and creating a custom treatment program that will allow you to return to normal activities pain-free.

Patient Forms

At PerformaX elite, we want to maximize your time with us. In an effort to save time on your first visit, please complete the Online Registration after you schedule your appointment. Then, print the following patient documents below if they apply to you, and fill them out and bring them with you to your first appointment. Otherwise, please allow extra time before your appointment to fill them out here.

Online Registration

Patient Intake

• 1

  Patient Intake & Consent Form

  This form is required for all new patients and it is important to complete all sections, including the date and your signature.

Additional Forms

Please complete these forms based on your specific diagnosis or problem area only – (i.e., back, neck, balance, hip, knee, ankle, foot, etc.).

• Back Index

  Download and Print

• Low Back Pain

  Download and Print

• Neck Pain

  Download and Print

• Shoulder Pain

  Download and Print

• Upper Extremity

  Download and Print

• Lower Extremity

  Download and Print

• Dizziness Inventory

  Download and Print

Before Your First Visit

• Make a list of questions that you have to discuss on your first visit.
• List signs and symptoms that can be of importance to the therapist.
• Have in writing key past medical history, previous treatments, current medications, and other important information.
• Please call our office to verify your insurance benefits.
• Arrive at least 15 minutes early for your first appointment.
• Bring with you a copy of your insurance card and a photo ID.

What to Expect on Your First Visit

• You will register with our friendly front office staff. They will help you navigate the insurance process and treatment program so you can focus on your recovery.
• You will meet with our physical therapist for the initial evaluation.
• During the evaluation, your therapist will ask questions about your medical history, current pain, or injury. Open communication helps us understand your problem.
• Your movement, strength, coordination, and much more will be evaluated. Our purpose is to help you, so please ensure you communicate with your therapist if anything is hurting or bothering you during the examination.
• Your therapist will recommend and prepare a course of treatments to ensure the quickest recovery and the best results. Your therapist will discuss the recommendations with you.
• There will be some treatments performed on the first day to get you started on your road to recovery. However, during the next visit, you will get into the full swing of your treatment plan.
• You will schedule your series of visits with the front desk. The amount of therapy needed will be discussed with you, depending on the recommendations of your therapist. We offer many convenient appointment times, however, prime times can become busy, so it is best to book ahead as much as possible.
• Your therapist will write up their findings and treatment plan to submit to your referring physician or another medical professional of your choosing.
• If you have any questions at any time, please don’t hesitate to call. We want to ensure your satisfaction and full recovery.