Your First Visit

All forms are fillable when you download and save them to your computer.

For Patients

Save valuable time at your first Fukuji & Lum PT visit by filling out new patient registration forms in the comfort of your own home.

Directions for downloading forms: Please download and save forms on your computer. Fill out forms, save and print.

Patient Registration Forms
Patient History Form
HIPAA Notice of Privacy Practices


For Physicians

For your convenience, you can download our physical therapy prescription and fax it to our clinic.

Prescription / Referral Form