"Optimizing Movements. Enhancing Lives. Proven Results."

Opening Hours : Monday - Thursday 7am - 7pm, Friday 7am - 1pm
  Contact : 904.217.4259 Fax: 904.217.4251

New Client Forms

Feel free to complete the forms prior to your initial appointment. If you have any questions, please feel free to email info@starsrehab.org or call 904.217.4259.

If you choose to print and complete the paperwork at home, please arrive 10 minutes prior to your initial evaluation

If you choose to complete the forms in the clinic, please arrive 20 minutes prior to your initial evaluation to complete them.

Remember to bring photo identification, insurance cards and the rx from the doctor (if applicable).


All New Patients




Intake Form

Medical History

Medicare Payer



Based on your diagnosis, you may choose an outcome measure to be done prior to your appointment.

Back Pain

Neck Pain

Shoulder Pain

Arm/Elbow/Hand Pain

Leg/Ankle/Foot Pain

Gait and Balance