Patient Intake Forms (414) 246-9184 Request Screening Request Appointment
At Franklin Rehab, we want to maximize your time with us. Prior to your first visit, please click on the applicable form below, fill out and submit online.
New Evaluation Form English (Fill out Online or Download)
Nueva Cita – Espanol (Completar en Línea o Descargar)
New Evaluation
Existing Patient
Medicare & Self-Pay Program
FAQ Insurance Info Free Patient Guides Privacy Policy 7 Questions to Ask Patient Intake Forms
Schedule A Free Pain Screening