Leaps and Bounds PT
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New Patient Paperwork

Please fill out the following documentation and bring it with you for your evaluation.  
Also, please make sure to bring your (parent's) picture ID, insurance card, and the script from your child's referring doctor.
(Scroll down for clickable and downloadable links)
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For All New Patients 
 Additional Paperwork for Schroth Treatment Patients Only
New Patient Paperwork
File Size: 2440 kb
File Type: pdf
Download File

Credit Card Authorization Form
File Size: 302 kb
File Type: pdf
Download File

Owestry Questionnaire
File Size: 2403 kb
File Type: pdf
Download File

BSS Questionnaire
File Size: 245 kb
File Type: pdf
Download File

SRS 22r Questionnaire
File Size: 1026 kb
File Type: pdf
Download File

TAPS.pdf
File Size: 256 kb
File Type: pdf
Download File

Picture
Insurance Based Pediatric Outpatient Rehabilitation

​LOCATIONS

SOUTH SHORE COMMONS
2955 Veterans Road West
Staten Island, NY 10309
(718) 477-1911

RICHMOND AVENUE
1550 Richmond Avenue
​Staten Island, NY 10314
(718) 313-4743
​About Us
Physical Therapy Services
Schroth Treatment
​Dynamic Movement Intervention
Continuing Education
​Join Our Team!
Blog
​Contact Us
Email Us! [email protected]
© COPYRIGHT 2015. ALL RIGHTS RESERVED.
  • Home
  • About Us
  • Meet Our Team
  • Physical Therapy Services
  • Schroth Treatment
  • DMI
  • Continuing Education
  • Join Our Team
  • Blog
  • Contact
  • Book
  • Leaps Marketplace