NEW PATIENTS

Welcome to Lifeline. If possible, please download, print, and fill out the forms below, then bring them with you to your first appointment. We’re looking forward to meeting you!


PREPARING FOR YOUR FIRST VISIT

Please arrive 15 minutes prior to your scheduled appointment to fill out any unfinished paperwork. Wear comfortable shoes and clothing.

PHYSICAL THERAPY

Bring your prescription (if you have one), insurance card, a list of your medications, and any testing or imaging results you may have.

PHYSICAL THERAPY FORMS

  1. Consent for Treatment Form
  2. Past Medical History Form

PULMONARY REHABILITATION

Bring your own supplemental oxygen tank and rescue inhaler, if applicable. Also bring your prescription, insurance card, and a list of your medications.

PULMONARY REHABILITATION FORMS

  1. Consent for Treatment Form
  2. Explanation of Pulmonary Rehabilitation Form
  3. CATest Form
  4. HADS Questionnaire Form
  5. Self Efficacy Form
  6. SOBQ Form
  7. MMRC Dyspnea Form
  8. Patient Skills Form

CARDIAC THERAPY

Bring your own supplemental oxygen tank and any medications you need, if applicable. Also bring your prescription, insurance card, and a list of your medications.

CARDIAC THERAPY FORMS

  1. Consent for Treatment Form
  2. Explanation of Cardiopulmonary Therapy Form
  3. CES-D Form
  4. The Duke Activity Status Form
  5. Rate Your Plate Form
  6. Education Assessment Form

LIFELINE PRIVACY POLICY

  1. Notice of Privacy
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