Print Referral Form

In order to see a physical therapist, it is necessary to obtain a medical prescription from your doctor, physicians' assistant, or nurse practitioner.

You can print an ISPT referral online by clicking one of the 3 links below. Three formats are available (HTML, PDF and GIF). Please view each format and print the one that looks the best. Please use your browser's BACK button to return to this screen after printing or viewing a referral form.

1. Referral Form (HTML)

2. Referral Form (PDF) - Requires Adobe Acrobat Reader