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	<html>
	<head>
	<title>Patient Forms & Resources</title>
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	<meta name="description" content="Learn about our outpatient services: occupational therapy, physical therapy and prosthetics ">
	<meta name="keywords" content="outpatient, rehabilitation, rehab, physical therapy, occupational therapy, prosthetics, orthotics, hand therapy">
	<style type="text/css">
		@import url(default.css);
		@import url("healthsystem.css");
	</style>
<link href="/favicon.ico" rel="icon" type="image/x-icon" />

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	function MM_preloadImages() { //v3.0
		var d=document; if(d.images){ if(!d.MM_p) d.MM_p=new Array();
			var i,j=d.MM_p.length,a=MM_preloadImages.arguments; for(i=0; i<a.length; i++)
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		if(!x && d.getElementById) x=d.getElementById(n); return x;
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			return r;
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	if(navigator.userAgent.indexOf('MSIE 6') > 0){
		addEvent(window, 'load', DHTMLIframeHeight);
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	//
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			</head>
	
		
	
	
	
	
		
			
		
	
	
	
	
		
			
		
	
	


<style type="text/css">
#lryParentmain56 {
	display:none;
	visibility:hidden;
}
</style>
<body style="margin:0px; background-color:#7082a6;" class="body">
<table width="90%" align="center" width="1%" bgcolor="ffffff" border="0" cellpadding="0" cellspacing="0" style="border:3px solid #ffffff;">
	<tr>
		<td>
			<table width="100%" height="28" border="0" cellpadding="0" cellspacing="0" bgcolor="e5ebeb" style="border-bottom:1px solid #d5dddd;">
				<tr valign="middle">
					<td width="33%" height="28" valign="middle" style="padding-left:20px;font-size:10px;">Sat May 18, 2013</td>
					<td width="33%" align="center" valign="middle">
						
	<!-- Begin NavBar Output  -  Version:  v0.79a 09/30/2006  -->
	
			
				
<script type="text/javascript">
//<!--
var ns4 = (document.layers);
var ie  = (document.all);
var ie4 = (ie && !document.getElementById);
var ie5 = (ie && document.getElementById);
var ns6 = (!ie && document.getElementById);

var aryMoused = new Array();
var aryLayerMoused = new Array();
var aryMoImages = new Array();
var imageList = new Array();
var runMouseOvers = true;
var TimerID = null;
var iLimit = 25;
var itmp = 0;

var nbTime = 100;
var nbTimes = 2;
var nbThisLoc = 325;
var aryLayerNames = new Array();
var aryNavBarLayerInfo = new Array();
var aryNavBarLayers = new Array();

var registeredObjects = new Array();
var viz = "hide";

function MOImage() {
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function BillzImagePreload() {
	// 0) html image name 1) mo image src 2)image Name for rollover key (rollover may have multiple mos for one html Image) 
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function nbImagePreload(img_name, mo_img_src, rollover_key_img_name) {
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	imageList[imageList.length] = imageKey;
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}

function BillzMouseover() {
	var arg = null;
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	return true;
}
// args 1) ImageName 2) OriginalSrc 3) array index (caller imagename)
function nbMouseover(img_name, orig_src, img_key) {
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}

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function BillzArrayPush(aryArray, varNewElement) { //Implement Array Push 'cause IE cant handle it
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function BillzArrayPop(aryArray) { //Implement Array Pop 'cause IE cant handle it before 5.5
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//v3.0 name changed to avoid clash with possible other JS in content, this function complements of MM Dreamweaver
function NavBarSwapRollover(swapimage,defaultimage,imageID) {
	if(imageID.length > 0 && document.getElementById(imageID))
	{
		if(swapimage.length > 0) 
			document.getElementById(imageID).src = "images/" + swapimage;
		else
			document.getElementById(imageID).src = "images/" + defaultimage;		
	}
}
function BillzNavBarMM_findObj(n, d) {
	var p,i,x;
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	else {		
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		registeredObjects[n] = x;
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	return x;
}

function BillzArrayContains() {
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		foundit = (arg[1] == arg[0][i]);
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}

function NavBarRegisterLayer() {
	var arg = NavBarRegisterLayer.arguments;
	var n = arg[0];
	var d = arg[1];
	var mo = false;
	var o = null;
	if (arg[2] && arg[2] == 'MOutLayer') mo = true;
	else mo = false;
	
	if (!(BillzArrayContains(aryLayerNames, n))) {
		if (o = BillzNavBarMM_findObj(n)) {
			aryNavBarLayers[n] = o;
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			aryNavBarLayerInfo[n] = new NavBarLayer(n, d, mo);
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	}
	return true;
}

function BillzNavBarMM_showHideLayers() {
	//v3.0 name changed, this function complements of MM Dreamweaver with customizations by Bill Heller
	var i = 0;
	var x = "";
	var obj = null;
	var v = null;
	var p = null;
	var args = BillzNavBarMM_showHideLayers.arguments;
	
	if (args[args.length - 1] != "menu") nbMouseOutTimer();
	for (i = 0; i < (args.length - 2); i += 3) {
		if (!aryNavBarLayers[args[i]]) {
			x = (args[i + 2] == 'show') ? 'hide' : 'show';
			NavBarRegisterLayer(args[i], x);
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			v = args[i + 2];
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			if (args[args.length - 1] == "restore") v = (v == 'show') ? 'hide' : 'show';
			
			if (obj.style) obj.style.visibility = (v == 'show') ? 'visible' : ((v == 'hide') ? 'hidden' : v);
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	return true;
}

function BillzNavBarRestoreLayers() {
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	var x = "";
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			v = aryNavBarLayerInfo[args[i]].defaultVisibility;
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			}
			obj.visibility = v;
			if (!aryNavBarLayerInfo[args[i]].MOutLayer) aryNavBarLayerInfo[args[i]].isDefault = true;			
		}
	}
	return true;
}

function NavBarLayer() {
	var arg = NavBarLayer.arguments;
	this.defaultVisibility = arg[1];
	this.isDefault = true;
	this.MOutLayer = arg[2];
	return true;
}

function BillzNavMove() {
	return nbNavMove();
}

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	var otherl = null;
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			viz = "hidden";
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														<h1 class="pagetitle" id="pagetitle"><strong>Rehab Departments</strong> / Patient Forms & Resources</h1>
													
												
											
										
										
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	<h2>For Patients</h2>
<p><font color="#ff0000"><strong>Attention first-time patients</strong></font></p>
<ul>
<li>Please arrive to your appointment 15 minutes early to complete the registration process.</li>
<li>Please print the appropriate forms below &amp; bring with you on your first appointment.</li>
</ul>
<h3>Westwood Campus</h3>
<ul>
<li>
<h3><a href="http://rehab.ucla.edu/workfiles/Outpatient%20PT/Patient%20Intake%20Assessment%20-%20Westwood%20-%20Adult%20%282013_04%29.pdf" title="UCLA Rehabilitation Services|Patient Intake Assessment - Westwood - Adult" target="_blank">Forms for adults &amp; children 8 years of age or older</a></h3>
</li>
<li>
<h3><a href="http://rehab.ucla.edu/workfiles/Outpatient%20PT/Patient%20Intake%20Assessment%20-%20Westwood%20-%20Pediatric%20%282013_04%29.pdf" title="UCLA Rehabilitation Services|Patient Intake Assessment - Westwood - Pediatric" target="_blank">Forms for&nbsp;children 7 years of age or younger</a></h3>
</li>
<li>
<h3><a href="http://rehab.ucla.edu/workfiles/Outpatient%20PT/Directions_Parking-OP-RehabWW2.pdf" target="_blank">Directions &amp; Parking</a></h3>
</li>
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<h3>Santa Monica Campus - 12th Street</h3>
<ul>
<li><a href="http://rehab.ucla.edu/workfiles/Outpatient%20PT/Patient%20Intake%20Assessment%20-%2012th%20St.%20-%20Adult%20%282013_04%29.pdf" title="UCLA Rehabilitation Services|Patient Intake Assessment - 12th St - Adult" target="_blank">Forms for&nbsp;adults &amp; children 8 years of age or older</a></li>
<li><a href="http://rehab.ucla.edu/workfiles/Outpatient%20PT/Patient%20Intake%20Assessment%20-%2012th%20St.%20-%20Pediatric%20%282013_04%29.pdf" title="UCLA Rehabilitation Services|Patient Intake Assessment - 12th St - Pediatric" target="_blank">Forms for&nbsp;children 7 years of age or younger</a></li>
<li>
<h2><a href="http://rehab.ucla.edu/workfiles/Outpatient%20PT/Directions%20-%20OP%20Rehab%2012th%20St%20.pdf" title="UCLA Rehabilitation Services|Directions and Parking - 12th St">Directions &amp; Parking</a></h2>
</li>
</ul>
<h3>Santa Monica Campus - 15th Street 
<ul>
<li><a href="http://rehab.ucla.edu/workfiles/Outpatient%20PT/Patient%20Intake%20Assessment%20-%2015th%20St.%20-%20Adult%20%282013_04%29.pdf" title="UCLA Rehabilitation Services|Patient Intake Assessment - 15th St - Adult" target="_blank">Forms for&nbsp;adults &amp; children 8 years of age or older</a></li>
<li><a href="http://rehab.ucla.edu/workfiles/Outpatient%20PT/Patient%20Intake%20Assessment%20-%2015th%20St.%20-%20Pediatric%20%282013_04%29.pdf" title="UCLA Rehabilitation Services|Patient Intake Assessment - 15th St - Pediatric" target="_blank">Forms for&nbsp;children 7 years of age or younger</a></li>
<li>
<h2><a href="http://rehab.ucla.edu/workfiles/Outpatient%20PT/Directions_Parking-OP-RehabSM2.pdf" target="_blank">Directions &amp; Parking</a></h2>
</li>
</ul>
</h3>
 
									
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