After completing the new patient form by clicking the above button, please upload a photo or copy file of your insurance below.
434 South Walnut Street
Bloomington, IN 47401
Please Print and complete the following forms prior to your first appointment:
Wingard Wellness & Therapy Services - Consent to Physical Therapy Evaluation and Treatment
Wingard Wellness & Therapy Services - Patient Intake History Form
Wingard Wellness & Therapy Services - Functional Dry Needling Patient Flyer
Wingard Wellness & Therapy Services - Functional Dry Needling Consent Form*
Wingard Wellness & Therapy Services - HIPAA Compliance Patient Consent Form
*Only complete the FDN consent form if you are receiving dry needling treatment. All signed forms will be collected at the start of your first visit.
