Patient Forms

Patient Forms

At Back in Motion Physical Therapy, we want to maximize your time with us. Prior to your first visit, please click on the applicable form below, fill out and submit online.

 

In-Clinic or At-Home Visit Intake Form:

New Evaluation English

Nueva Cita – Espanol

 

Virtual Visit Intake Forms:

New Evaluation

Existing Patient

Medicare & Self-Pay Program

 

 

Notice of Privacy Practices

Notice of Privacy Practices – English / Spanish

Get started on the journey back to being you.
From your first visit with us, you’ll find people who are dedicated to your health, well-being, and making your care as pleasant as possible.

Our Locations

Gorham

94 Main Street #2
Gorham, ME 04038

Phone: (207) 839-5860
Fax: (207) 839-2499

South Portland

185 Ocean Street
South Portland, ME 04106

Phone: (207) 799-8226
Fax: (207) 799-9340

Portland

1041 Brighton Avenue
Portland, ME 04102

Phone: (207) 699-4111
Fax: (207) 773-8814

Newport

4 Main Street Unit T2
Newport, ME 04953

Phone: (207) 924-0077
Fax: (207) 924-0078

Brewer

797 Wilson Street
Brewer, ME 04412

Phone: (207) 992-4042
Fax: (207) 992-4043

Waterville

120 Elm Plaza
Waterville, ME 04901

Phone: (207) 707-4789
Fax: (833) 989-0156

Auburn

600 Turner Street Suite 2A
Auburn, ME 04210

Phone: (207) 707-4788
Fax: (833) 702-9005