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