Patient Information Forms

Please fill out the following forms to the best of your abilities. For the medical history information, such as heart attacks, etc., please indicate whether you are or a relative have suffered from the ailment.

Service Agreement and Patient Privacy

  • Click here for Service Agreement Form (please print, fill out and bring to your appointment)
  • Click here for Patient Privacy Form (please print, fill out and bring to your appointment)

Infection Control Plan

In order to protect our staff, patients and community, we will be instituting infection control measures as outlined in our infection control plan. The plan and its measures are dynamic in nature and may change based on current level of risk or other directives from federal or state agencies. 


Protected Form

Corporate Partners

The purpose of the corporate partnership program is to bring together like-minded companies that compliment one another’s mission as well as to help our clients and patients receive the best healing and performance products on the market today. The Positional Release Therapy Institute seeks corporate partners that have demonstrated an exceptional product line or service(s) that bolster the effectiveness of our therapy and the services our company provides. Additionally, we seek corporate partners who have also demonstrated exceptional quality service and integrity.

Foot Management Doctor Hoy's Natural Pain Relief

Interested in Becoming a Corporate Partner? Contact Us Today