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Patient Forms

Save time on your first visit and fill out forms in advance. All new patients will need to complete the Medical History Form, Patient Responsibilities Form and Medical Log.  If you have never been seen at a Bon Secours facility, please also complete the Patient Registration Form.

Please let us know your medical history to help gain an adequate understanding of your current situation.

Download all patient forms.

(RHTC) Richmond Hope Therapy Clinic outpatient registration form.

Patient email and text message informed consent.

Nutrition packet.

Medical History Form

  • What it is: A questionnaire that helps us to understand the big picture of your health. This form indicates you understand what is expected of you as a patient at Bon Secours Sports Medicine and Physical Therapy.

Outpatient Registration Form – If you are NOT an active Bon Secours patient or have NEVER been seen at a Bon Secours facility, you are new to our system.  Please complete the Registration Form.

  • What it is: Your basic information, the first building block of your patient file.
  • Tip: At the bottom of the form, patients are asked if they have Advanced Directive documents, which include your Living Will and your Medical Power of Attorney plan.

Patient Responsibilities Form – Please fill out the patient responsibility form for your visit.

  • What it is: This form lets you know what we expect from our patients during appointments and what you can expect from us.
  • Tip: By being a responsible patient, we can work together to provide the best possible care and therapeutic outcomes.