Hand & Upper Extremity Rehabilitation

If you are new to our clinic, please fill out the following forms.

For Hand & Upper Extremity Rehabilitation Patients:

All Patients:

• Intake Form
• HIPPA Form

Medicare Patients: Please fill out the Medicare Benefits Form as well as the forms above.

For Arlington Lymphedema Center Patients:

All Patients:

• Intake Form
• HIPPA Form

Medicare Patients: Please fill out the Medicare Benefits Form as well as the forms above.

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Hand & Upper Extremity Rehabilitation
911-A Medical Centre Drive, Arlington, TX 76012 (817) 861-7600     Fax: (817) 861-7601
305 Regency Parkway, Suite 605, Mansfield, TX 76063 (817) 789-9105     Fax: (817) 861-7601
Copyright © 2009 Hand & Upper Extremity Rehabilitation. All Rights Reserved.