Patient Forms

Patient Forms

At Back in Motion Physical Therapy, we want to maximize your time with us. Prior to your first visit, please follow the steps below:


In-Clinic or At-Home Visit:

Click on New Patient Forms, fill out and submit online.


Virtual Visit:

Click on the Patient Form that applies to you, fill out and submit online.

First Time or Returning:

Patient Information & Consent Forms

Medicare & Self-Pay:

Patient Self-Pay Program

Currently Being Seen:

Virtual Visit Consent for Treatment


*Note: Based on insurance there may be additional paperwork

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

94 Main Street #2
Gorham, ME 04038

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

185 Ocean Street
South Portland, ME 04106

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

1041 Brighton Ave
Portland, ME 04102

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

4 Main Street Unit T2
Newport, ME 04953

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

797 Wilson Street
Brewer, ME 04412

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