Forms

For your convenience we have provided copies of our clinical forms. By filling out these forms prior to your arrival we will be able to initiate your services more efficiently. Please don’t hesitate to call if you have any questions. If you need a language interpreter, please let Freeborn Wellness know in advance so that we may help coordinate this additional service.¬†We look forward to welcoming you!

Client Intake Forms

  • Nutrition
  • Massage
  • OT/PT
  • Work Conditioning/Work Hardening
  • Functional Capacity Evaluation

Referring Provider Forms

  • Referrals
  • Pre-Authorization Assessment for L&I Weight Management