Rehabilitation/Therapy Forms
To schedule an appointment, please call Outpatient Therapy Scheduling at 574-647-2600. Fax orders to 574-239-6460.
Outpatient Therapy Services Order Form
Memorial's Outpatient Therapy Services can serve any of the following needs
- Physical Therapy
- Pool Therapy
- Vestibular/Balance Rehab
- Speech/Language Pathology
- Brain Injury Program
- Neuropsychological Services
- Driver evaluation
- Occupational Therapy
- Hand Therapy (OT/PT)
- Functional Capacity Evaluation
- Work Hardening/Conditioning
- Back School
- Pelvic Floor/Incontinence Program
- Augmentative Communication
- Lymphedema Program





