Patient Forms

The Pain Treatment & Wellness Center looks forward to adding you to our list of satisfied patients/clients. To schedule an appointment, please call 724-853-2353 or complete our online appointment request form.

In order to save you some time at the office, we provide our intake forms here for you to download and complete at home. You may need 15 to 20 minutes to complete these forms thoroughly.

The forms are broken down by Myofascial Trigger Point Therapy and Massage Therapy so be sure to select the correct file(s).

Myofascial Trigger Point Therapy

Dowload The PDF Form

Trigger Point Therapy Intake form
Dowload The PDF Form

Trigger Point Therapy Referral Form(prescription, referral, med.pdf) 
Have your doctor complete and sign this form if you are an auto or work comp case.

Massage Therapy

Dowload The PDF Form

Massage Therapy Intake form

NOTE: All forms require the FREE Adobe Acrobat Reader.
You can download the reader HERE.

Get the Free Adobe Acrobat Reader