Empower Physical Therapy & Wellness

Patient Paperwork

Complete your forms at home so your first visit starts with treatment, not a clipboard. Download each one below, fill it out at your own pace, and bring the printed copies with you, or email them ahead so our team can have everything ready and reviewed the moment you walk through the door. It takes a few minutes now and saves you time later.

Book an Appointment →

01Download Your Forms

One form. A few minutes. Zero waiting room clipboard.

New Patient Forms

Your contact details, pain history, and goals for treatment.

Download →

Good to Know

Can't print at home? Arrive 15 minutes early and we'll have everything ready.

Request an Appointment

Ready when you are.

HoursMon/Wed/Thu 9am–6pm · Tue/Fri 8am–5pm

Walk-insCall ahead

Book your evaluation. We'll call to confirm your time.

Step 1 of 6

First things first. What's your name?

Full Name

We'll need a name to book you in.

Best number to reach you?

Phone

A phone number lets us confirm same-day.

And your email?

We'll send your confirmation here.

What questions do you have about your pain or injury?

e.g. What's going on and what are your goals

A few words is all we need.

Which location would you like to visit?

ChinoChino HillsPomona

Pick the clinic that works best for you.

Look right? Send it.

✓

Request received.

We'll call within business hours to lock in your time.