Outpatient Admission Forms

Thank you for choosing to receive outpatient therapy at St. Luke's Rehabilitation Institute; we look forward to working with you. Please choose the form(s) that correspond to the program you will be participating in to complete prior to your first visit and sign and date accordingly. By filling these forms out ahead of time, you will decrease the amount of time you would normally spend in the waiting room.

If you have any questions or need help with forms, please contact our admitting department at (509) 473-6869 or email us. Our hours of operation are 8 a.m. to 5 p.m. Monday through Friday. Financial assistance is available for those who meet St. Luke's Rehabilitation Institute's guidelines. If you are in need, please contact the Patient Accounts department at 509-476-6003 or 1-866-257-3599 for more information or download the application.

All Patients Must Review And Complete: 

Biofeedback Patients Must Also Complete:

Pulmonary Patients Must Also Complete:

Cardiac Patients Must Also Complete:

Incontinence Patients Must Also Complete:

Pediatric Patients Must Also Complete: