Form 1: Complete if a new inquiry does not schedule a visit. First Name Last Name Email* Is patient a good fit? Patient's not ready yet Not a good fit Submit Marketing by ActiveCampaign Form 2: Complete if a new inquiry schedules an evaluation and follow-up visits. New Patient Goals (After Eval) Please enter your patient's #1 goal and treatment program name here. This is the transformational goal that you've isolated is the real reason they are here for PT. This form automatically triggers our welcome email to be sent to the new patient with instructions after their visit. If you don't have a special "name" for the treatment program, just enter "Physical Therapy" Patient's First Name* Patient's Last Name* Patient's Email Address On File or Used for Scheduling* Patient's #1 Important Goal for Physical Therapy & Life* Treatment Program* Submit Form 3: Complete this form after the patient’s evaluation. Goals can be found in their chart. Form 4: Complete this form if the patient is finished with PT and is being discharged. Form 5: Archived Patient: Complete after a patient has been sent the Archive Email. Form 6: Summit Wellness Program: Send to patients that are almost done with their plan of care to introduce the Summit Wellness Program.
