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Benchmark Physical Therapy and Wellness Center


4964 Benchmark Centre Drive • Swansea, IL 62226       

New Patient Forms
  1. Click to download file and open with Adobe Reader
  2. If you do not have Adobe Reader click the icon below to download for free.
  3. Bring the completed forms with you on your next office visit.

Patient Self-Evaluation: click to download

Registration Form: click to download

Consent For Release of Medical Information: click to download

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