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


Patient Admission Forms

All Patients Must Review And Complete: 

Cardio Pulmonary Patients Must Also Complete:

Pulmonary Only Patients Must Also Complete:

Cardiac Only Patients Must Also Complete:

Incontinence Patients Must Also Complete:

Pediatric Patients Must Also Complete:

Questions? Call us at (509) 473-6000.

St. Luke's Rehabilitation Institute
711 S. Cowley St.
Spokane, WA 99202-1330
509.473.6000

Inpatient Information: (509) 473-6058
Outpatient Information: (509) 473-6869