New Patient Forms

Below you will find new patient forms:

  1. Before arriving for your first appointment at Costa Mesa Physical Therapy, please fill out the functional scale new patient form that is most applicable to your injury by clicking on the proper box below, then download, print, and complete that form.  (Our forms are PDF files. To download and print the forms, you’ll need the free Adobe Acrobat Reader program.)
  2. Please bring or email these forms fully completed to your initial physical therapy visit.

If you choose instead to fill out the new patient forms at our office, please arrive 20 minutes prior to your appointment to complete the required paperwork.

If you have any questions please feel free to contact us at 714-427-0803 or email us at

Foot, Calf, Thigh (Leg Lower Extremity)
Leg, Foot, Hip (Lower Extremity)
Hand, Arm, Shoulder (Upper Extremity)
Hand, Arm, Shoulder (Upper Extremity)