Patient Forms

For Patients looking to learn more about Imago

• Click here to access our new patient inquiry form.

For patients ready to get started with Imago

• Click here to access new patient intake form and our intake team will begin the process of validating your insurance coverage.

For patients preparing for their first appointment

• Please make sure you have completed our video intake process which allows us to monitor your progress over time. Access that video intake here.
• In addition, please make sure you have reviewed, and where applicable, signed the forms below. If there is a form that you have not yet signed, you can click on the link and it will generate an email to our patient intake team.

General policies

• Imago Notice of Privacy Practices
• Late, Missed and Canceled Appointment Policy

Consents & Agreements (signature required)

• Request HIPAA Acknowledgement & Consent
• Request Patient Authorization & Guarantee Form
• Request Patient Financial Agreement

 

Imago Rehab’s mission is to help individuals with physical impairment due to a neurological condition, improve function and restore independence to through accessible, evidence-based care.

Our vision is to revolutionize stroke rehabilitation by offering a platform that combines telerehabilitation, innovative robotic devices, and an integrated care team to enable superior recovery outcomes.