Patient Info / Forms

Welcome to Ascent Physical Therapy

We are here to help you enjoy your life, pain-free! To make a convenient appointment, simply call us today 503.427.0118. Our practice is dedicated to helping our patients identify the cause of their pain and creating a custom treatment program that will allow them to return to normal activities pain-free.

Intake Form

At Ascent Physical Therapy, we want to maximize your time with us. Prior to your first visit, please complete the Online Intake Form below and submit that online.

Online Intake Form

Before Your First Visit

  • Make a list of questions that you have to discuss on your first visit.
  • List signs and symptoms that can be of importance to the physical therapist.
  • Have in writing key past medical history, previous treatments, current medications, and other important information.
  • Please call our office to verify your insurance benefits.
  • Arrive 15 minutes early for your first appointment.
  • Bring with you a copy of your insurance card and a photo ID.

What to Expect on Your First Visit

  • You will register with our friendly front office staff. They will help you navigate the insurance process and treatment program so you can focus on your recovery.
  • You will meet with your physical therapist for the initial evaluation.
  • During the evaluation your physical therapist will ask questions about your medical history, current pain, or injury. Open communication helps us understand your problem.
  • Your movement, strength, coordination, and much more will be evaluated. Our purpose is to help you, so please ensure you communicate to your physical therapist if anything is hurting or bothering you during the examination.
  • Your physical therapist will recommend and prepare a course of treatments to ensure the quickest recovery and the best results. Your physical therapist will discuss the recommendations with you.
  • There will be some treatments performed the first day to get you started on your road to recovery. However, during the next visit you will get into the full swing of your treatment plan.
  • You will schedule your series of visits with the front desk. The amount of therapy needed will be discussed with you, depending on the recommendations of your physical therapist. We offer many convenient appointment times, however prime times can become busy, so it is best to book ahead as much as possible.
  • Your physical therapist will write up their findings and treatment plan to submit to your referring physician or other medical professional who you choose.
  • If you have any questions at anytime, please don’t hesitate to call. We want to ensure your satisfaction and full recovery.

Health Insurance

We gladly accept most insurance plans. Please call us to verify your insurance as we are always adding new insurance plans.

As a courtesy to our patients, we will verify your health benefits prior to your arrival to determine if there will be a copay, deductible, or coinsurance for therapy services. For those patients who do not have health insurance or those who have maxed out their benefits, we offer a private pay plan.  Please contact us today for more information on our fees for service and payment details.

Notice of Nondiscrimination and Accessibility Rights

Discrimination is Against the Law

Ascent Physical Therapy complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Ascent Physical Therapy does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

Ascent Physical Therapy:

  • Provides free aids and services to people with disabilities to communicate effectively with us, such as: Qualified sign language interpreters, Written information in other formats (large print,
    audio, accessible electronic formats, other formats).
  • Provides free language services to people whose primary language is not English, such as: Qualified translators, Information written in other languages If you need these services, contact Ascent Physical Therapy.

If you believe that Ascent Physical Therapy has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with:

Ascent Physical Therapy:
16126 SE Happy Valley Town Center Dr. Ste 200
Happy Valley, OR 97086
P: (503)-427-0118
F: (503)-427-0279
contact@ascentptnw.com

You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, our Patient Advocacy Department is available to help you.

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal,  vailable at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:

U.S. Department of Health and Human Services
200 Independence Avenue, SW
Room 509F, HHH Building
Washington, D.C. 20201
1-800-368-1019 or 800-537-7697 (TDD)

Complaint forms are available at: http://www.hhs.gov/ocr/office/file/index.html.

Spanish: ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al (503)-427-0118.

Chinese:注意:如果您使用繁體中文, 您可以免費獲得語言援助服務. 請致電 (503)-427-0118.

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Japanese: 注意事項:日本語を話される場合、無料の言語支援をご利用いただけます(503)-427-0118まで、お電話にてご連絡ください.

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Mon-Khmer, Cambodian: ប្រយ័ត្ន៖ បើសិនជាអ្នកនិយាយ ភាសាខ្មែរ, សេវាជំនួយផ្នែកភាសា ដោយមិនគិតឈ្នួល គឺអាចមានសំរាប់បំរើអ្នក។ ចូរ ទូរស័ព្ទ (503)-427-0118។

Hindi:ध्यान दें: यदि आप हिंदी बोलते हैं तो आपके लिए मुफ्त में भाषा सहायता सेवाएं उपलब्ध हैं। (503)-427-0118 पर कॉल करें।

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Thai: เรียน: ถ้าคณพดภาษาไทยคณสามารถใช้บริการช่วยเหลือทางภาษาได้ฟรี โทร (503)-427-0118

German: ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: (503)-427-0118.

Urdu: (503)-427-0118 خبردار: اگر آپ اردو بولتے ہیں، تو آپ کو زبان کی مدد کی خدمات مفت میں دستیاب ہیں ۔ کال کریں .

Ukrainian: УВАГА! Якщо ви розмовляєте українською мовою, ви можете звернутися до безкоштовної служби мовної підтримки. Телефонуйте за номером (503)-427-0118.

French: ATTENTION: Si vous parlez français, des services d’aide linguistique vous sont proposés gratuitement. Appelez le (503)-427-0118.

Laotian: ໂປດຊາບ: ຖ້ າວ່ າ ທ່ ານເວ້ າພາສາ ລາວ, ການບິລການຊ່ ວຍເຫຼ ອດ້ ານພາສາ, ໂດຍ່ບເສັ ຽຄ່ າ, ແມ່ ນມພ້ ອມໃຫ້ ທ່ ານ. ໂທຣ (503)-427-0118.

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Italian: ATTENZIONE: In caso la lingua parlata sia l’italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare il numero (503)-427-0118.

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Pennsylvanian (Dutch): Schwetzscht, kannscht du mitaus Koschte ebber gricke, ass dihr helft mit die englisch Schprooch. Ruf selli Nummer uff: Call (503)-427-0118.