Resources/Forms

Outpatient Rehabilitation New Patient Forms

In order to make better use of your time at Penn Therapy & Fitness, we have provided you with registration forms to be printed and completed prior to arriving at your first appointment. The forms below enable us to learn about your condition and how it affects your daily life, understand your overall health, track the effectiveness of your rehabilitation and accurately bill your insurance.

Click here to download the Penn Therapy & Fitness Welcome Packet forms

Charity Care

If you have little or no health insurance to pay for the services you receive, Good Shepherd Penn Partners may be able to help. Good Shepherd Penn Partners provides charity care to some patients based on their income, assets and financial needs. If you are not eligible for charity care, we will arrange an interest-free payment plan to resolve any balances you may owe.

To apply for charity care from Good Shepherd Penn Partners, first read Good Shepherd Penn Partners Notice of Financial Aid and our policy. If you feel that you may qualify for charity care, download Good Shepherd Penn Partners charity care application (.pdf), complete the form and return it to:

Director of Patient Financial Services
850 S. Fifth Street
Allentown, PA 18103
Fax: 610-776-8385

A representative will contact you within a few days.

These documents are also available in Spanish:

 Click here to review our HIPPA statement.

Click here to review our Patient Bill of Rights.