City Center Rehabilitation
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    • Neck Disability Index
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Forms

City Center Rehabilitation Forms

Save time by filling out our forms before your appointment. To help avoid wait time in our office please download and fill out the necessary form for your treatment.

  • Intake Form – Medicare
  • Intake Form – Non-Medicare
  • Health Insurance Portability and Accountability Act (HIPAA)
  • Quick DASH
  • Optimal
  • Oswestry Disability Index
  • Lower Extremity Functional Scale
  • Neck Disability Index

Have a question about what you need for your appointment?

Fill out our online form or call 815-223-4479.

Location

1627 4th Street
Peru, IL 61354

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Contact Us

Phone 815-223-4479
Fax 815-223-4489

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Hours

Monday - Friday:
8:00am - 6:00pm

Saturday & Sunday:
Closed

Forms

  • Intake Form - Medicare
  • Intake Form - Non-Medicare
  • HIPAA
  • Quick DASH
  • Optimal
  • Oswestry Disability Index
  • Lower Extremity Functional Scale
  • Neck Disability Index
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