Patient Forms

Thank you for choosing our Physical and Occupational Therapy Program to provide services for your needs. We hope and expect that our services will meet your needs in a pleasant environment.

To ensure that all therapy sessions run smoothly and you have the best possible experience, we have provided the necessary forms for new patients below. Each is available in PDF format and can be downloaded, printed and completed to bring with you on the first visit.

Barnabas Health Ambulatory Care Center
Adult Occupational and Physical Therapy Services
200 South Orange Avenue Suite 10, Livingston, NJ 07039
Phone: 973-322-7500 ; Fax: 973-322-7545

Patient Summary List / Pain Questionnaire (pdf)
Cancellation policy - ACC (pdf)

Saint Barnabas Medical Center’s Outpatient Physical Rehabilitation Center in Millburn
120 Millburn Ave, Suite 206, Millburn, NJ 07041
Phone: 973-921-0480; Fax: 973-921-0484

Patient Summary List / Pain Questionnaire (pdf)
Cancellation policy - Millburn (pdf)

Saint Barnabas Medical Center Rehabilitation at the JCC MetroWest
760 Northfield Ave, West Orange, NJ 07052
Phone: 973-325-9100; Fax: 862-252-9008

Patient Summary List / Pain Questionnaire (pdf)
Important Arrival Information and Instructions (pdf)
Cancellation policy - JCC (pdf)

Saint Barnabas Medical Center Adult Speech Therapy Department
375 Mount Pleasant Avenue, Suite G100-A, West Orange, NJ 07052
Phone: 973-969-3209; Fax: 973-969-3415

Adult Cognitive Intake Packet (pdf)
Adult Dysphagia-Swallowing Intake Packet (pdf)
Adult Speech and Language Intake Packet (pdf)
Adult Voice Intake Packet (pdf)
Cancellation Policy - Peds Rehab, Peds Speech, Adult Speech (pdf)

Patient Stories

  • Lisa made me feel at ease immediately. She tested my voice, suggested voice exercises, role modeled them, and allowed my son to take video of me mirror imaging Lisa for practice at home

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  • In only a few weeks, under the care of the experienced team who take a multidisciplinary approach to brain injury,

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Patient Stories

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