Online Forms

Initial Evaluation Forms

Prior to your first appointment, we ask that all of our patients fill out a Consent Form and the COVID-19 Questionnaire.

If you are in a High-Risk Category for COVID-19 (see form below), please also complete that form prior to your first appointment. 

If you wish to book your appointment online, please use your full, legal name. If you have been a patient in the past with Dubuque Physical Therapy, we ask that you also please use the same date of birth, name and phone number you have used in the past. This helps prevent duplicates. Thank you!

Please complete prior to your first appointment.

Please complete prior to your first appointment.

Please complete prior to your first appointment, if you are in a High-Risk Category for COVID-19.


Additional Forms

Please complete prior to Laser Therapy.

Please complete prior to Dry Needling Therapy.

Tri-State Running Series

"Training to Run" and "Training to Perform"