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  • PEDIATRICS
    • Conditions
      • Autism spectrum disorders/Asperger’s Syndrome
      • Central Auditory Processing Disorder
      • Childhood apraxia of speech
      • Developmental delays
      • Down syndrome
      • Dysphasia
      • Expressive and Receptive language delays/disorders
      • Fine Motor & Pre-School Skills
      • Genetic disorders
      • Gross Motor Impairment
      • Neurological disorders
      • Orthopedic disorders
      • Pediatric Sports Injuries
      • Sensory Processing Disorders
      • Speech sound disorders
      • Voice Disorders
    • Treatments
      • Augmentative and Alternative Communication Device Therapy
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      • Speech therapy
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      • ADHD
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    • Treatments
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    • Audiometric Hearing Tests
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  • Home
  • About Us
    • Our Practice
    • Our Locations
    • Our Team
    • Join Our Team
  • Physical & Occupational Therapy
    • Conditions
      • Back Pain & Sciatica
      • Neck Pain
      • Hip and Knee Pain
      • Foot and Ankle Pain
      • Shoulder Pain
      • Elbow Wrist & Hand Pain
      • Arthritis
      • Balance & Gait Disorders
      • Chronic Pain Relief
      • Dizziness & Vertigo
      • Fibromyalgia
      • Headaches
      • Lymphedema
      • Motor Vehicle Accident Injuries
      • Neurological Conditions
      • Pre/Postnatal Pain Relief
      • Pre-Surgical PT
      • Post-Surgical Rehabilitation
      • Sports Injuries
      • TMJ Dysfunction
      • Total Joint Rehabilitation
      • Work Injuries
      • View More Conditions
    • Treatments
      • Athletic Training
      • Aquatic Therapy
      • Balance Therapy
      • Concussion/Impact Training
      • Conditioning & Endurance Therapy
      • Core Stability Training
      • Dry Needling
      • Electrical Stimulation Therapy
      • Ergonomic Training
      • Functional Movement Screening
      • IASTM
      • Hand Therapy
      • Joint Mobilization
      • Kinesio Taping
      • Long-Term Care Services
      • Lympathic Therapy
      • Manual Therapy
      • Myofascial Release
      • Occupational Therapy
      • Orthotics
      • Physical Therapy
      • Post-COVID19 Recovery
      • Splinting
      • Strength Training
      • Traction
      • Therapeutic Exercise
      • Ultrasound Therapy
      • Vestibular Rehab
      • Women’s Health
  • Speech Therapy
    • Conditions
      • Aphasia
      • Autism spectrum disorders/Asperger’s Syndrome
      • Central Auditory Processing disorder
      • Childhood apraxia of speech
      • Down syndrome
      • Dysphagia
      • Dysphasia
      • Expressive and Receptive language delays/disorders
      • Genetic disorders
      • Neurological disorders
      • Speech Sound Disorders
      • Voice Disorders
    • Treatments
      • Augmentative and Alternative Communication Device Therapy
      • LSVT Loud
      • Play-Based Therapy
      • Speech Therapy
      • Stroke Rehabilitation
      • Swallow Treatment
      • VitalStim Therapy
  • PEDIATRICS
    • Conditions
      • Autism spectrum disorders/Asperger’s Syndrome
      • Central Auditory Processing Disorder
      • Childhood apraxia of speech
      • Developmental delays
      • Down syndrome
      • Dysphasia
      • Expressive and Receptive language delays/disorders
      • Fine Motor & Pre-School Skills
      • Genetic disorders
      • Gross Motor Impairment
      • Neurological disorders
      • Orthopedic disorders
      • Pediatric Sports Injuries
      • Sensory Processing Disorders
      • Speech sound disorders
      • Voice Disorders
    • Treatments
      • Augmentative and Alternative Communication Device Therapy
      • Pediatric Therapy
      • Play based therapy
      • Self-care skills
      • Sensory Integration
      • Speech therapy
  • COUNSELING
    • Conditions
      • ADHD
      • Adjustment Disorder
      • Anger Management
      • Anxiety
      • Behavioral Issues
      • Depression
      • Disruptive Mood Dysregulation Disorder
      • Grief
      • Obsessive Compulsive Disorder (OCD)
      • Post-Traumatic Stress Disorder (PTSD)
    • Treatments
      • Cognitive Behavioral Therapy
      • Dialectical Behavioral Therapy
      • Eye Movement Desensitization & Reprocessing (EMDR)
      • Faith Based Therapy
      • Family Systems Model
      • Marriage & Couples Therapy
      • Mediation
      • Motivational Therapy
      • Play Therapy
      • Trauma Therapy
      • Resources
  • Occupational Health
    • Audiometric Hearing Tests
    • DOT/Non-DOT Drug & Alcohol Collection
    • DOT Physicals
    • Drug/Alcohol Programs
    • Ergonomic Initiative Program
    • Functional Capacity Evaluations
    • On-site ergonomic assessments
    • Pre-Employment/Pre-Placement Exam
    • Pulmonary Function Testing (PFT)
    • Respirator Fit Test
    • Workplace Safety
    • WorkWell Systems
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Home » Patient Information » Patient Info / Forms

Patient Info / Forms

Are you living with pain? At Therapy Solutions, we are dedicated to helping you identify the cause of your pain and creating a custom treatment program that will allow you to return to normal activities pain-free.

At our Dickinson, Killdeer, and Richardton, ND physical, occupational, and speech therapy clinic, we are here to help you enjoy your life, pain-free!

To make an appointment at your convenience, simply call us today at (701) 483-1000 or click here to request an appointment.

What you should expect from your first visit with us:

  • You will register with our friendly front office staff. They will help you navigate the insurance process and treatment program so you can focus on your recovery.
  • You will meet with our physical therapist for the initial evaluation.
  • During the evaluation, your therapist will ask questions about your medical history, current pain, or injury. Open communication helps us understand your problem.
  • Your movement, strength, coordination, and much more will be evaluated. Our purpose is to help you, so please ensure you communicate to your therapist if anything is hurting or bothering you during the examination.
  • Your therapist will recommend and prepare a course of treatments to ensure the quickest recovery and the best results. Your therapist will discuss the recommendations with you.
  • There will be some treatments performed the first day to get you started on your road to recovery. However, during the next visit you will get into the full swing of your treatment plan.
  • You will schedule your series of visits with the front desk. The amount of therapy needed will be discussed with you, depending on the recommendations of your therapist. We offer many convenient appointment times, however, prime times can become busy, so it is best to book ahead as much as possible.
  • Your therapist will write up their findings and treatment plan to submit to your referring physician or another medical professional who you choose.
  • If you have any questions at any time, please don’t hesitate to call. We want to ensure your satisfaction and full recovery.

How you should prepare for your visit:

  • Bring with you a copy of your insurance card and a photo ID.
  • Arrive 15 minutes early for your first appointment.
  • Please call our office to verify your insurance benefits.
  • Make a list of questions that you have to discuss on your first visit.
  • List signs and symptoms that can be of importance to the therapist.
  • Have in writing key past medical history, previous treatments, current medications, and other important information.

Ready to get started? You can fill your new patient forms beforehand!

If you would like to save time on your first visit, please print the following patient documents below, fill them out, and bring them with you to your first appointment.

  • 1

    Client Intake

    Download & Print
  • 2

    Client Insurance

    Download & Print
  • 3

    Client Financial & Billing Procedures

    Download & Print
  • 4

    Client Consent

    Download & Print
  • 5

    Medical History

    Download & Print
  • 6

    Privacy Practice Notice

    Download & Print
  • 7

    Referral Form

    Download & Print

Don’t have time to print them off beforehand? No worries! Simply allow extra time before your appointment to fill them out in our clinic. At Therapy Solutions, we are here to help you get the most out of your visit – contact us today!

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3 CONVENIENT LOCATIONS

Dickinson, ND

1679 6th Ave West
Dickinson, ND 58601

Phone: (701) 483-1000

Fax: (701) 483-1001

myhealth@therapy-solutions.net

Killdeer, ND

*Temporary Location
215 Central Ave SE
Killdeer, ND 58640

Phone: (701) 483-1000

Fax: (701) 483-1001

myhealth@therapy-solutions.net

Richardton, ND

215 3rd Ave West
Richardton, ND 58652

Phone: (701) 483-1000

Fax: (701) 483-1001

myhealth@therapy-solutions.net

PT & OT CONDITIONS

  • Arthritis
  • Back Pain & Sciatica
  • Balance & Gait Disorders
  • Chronic Pain Relief
  • Dizziness & Vertigo
  • Elbow Wrist & Hand Pain Relief
  • Fibromyalgia
  • Foot and Ankle Pain Relief
  • Headaches
  • Hip and Knee Pain Relief
  • Lymphedema
  • Motor Vehicle Accident Injuries
  • Neck Pain Relief
  • Neurological Conditions
  • Post-Surgical Rehabilitation
  • Pre-Surgical PT
  • Pre/Postnatal Pain Relief
  • Shoulder Pain
  • Sports Injuries
  • TMJ Dysfunction
  • Total Joint Rehabilitation
  • Work Injuries

SPEECH THERAPY CONDITIONS

  • Aphasia
  • Autism spectrum disorders/Asperger’s Syndrome
  • Central Auditory Processing disorder
  • Childhood apraxia of speech
  • Down syndrome
  • Dysphagia
  • Dysphasia
  • Expressive and Receptive language delays/disorders
  • Genetic disorders
  • Neurological disorders
  • Speech Sound Disorders
  • Voice Disorders

Pediatrics

  • Autism spectrum disorders/Asperger’s Syndrome
  • Central Auditory Processing Disorder
  • Childhood apraxia of speech
  • Developmental delays
  • Down syndrome
  • Dysphasia
  • Expressive and Receptive language delays/disorders
  • Fine Motor & Pre-School Skills
  • Genetic disorders
  • Neurological disorders
  • Orthopedic disorders
  • Pediatric Sports Injuries
  • Sensory Processing Disorders
  • Speech sound disorders
  • Voice Disorders

COUNSELING

  • ADHD
  • Adjustment Disorder
  • Anger Management
  • Anxiety
  • Behavioral Issues
  • Depression
  • Disruptive Mood Dysregulation Disorder
  • Grief
  • Obsessive Compulsive Disorder (OCD)
  • Post-Traumatic Stress Disorder (PTSD)

Occupational Health

  • Audiometric Hearing Tests
  • DOT/Non-DOT Drug & Alcohol Collection
  • Drug/Alcohol Programs
  • Ergonomic Initiative Program
  • Functional Capacity Evaluations
  • On-site ergonomic assessments
  • Pre-Employment/Pre-Placement Exam
  • Pulmonary Function Testing (PFT)
  • Respirator Fit Test
  • Workplace Safety
  • WorkWell Systems
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