Emotional and physical health go together, please fill out this form and the Client Symptom Checklist and you will recieve a call within 24 hours. Thank you for choosing Riverside Rehab Services Physical Therapy, Occupational.– This form should be updated if marital status changes in the course of treatment. Simply fill in the form below and we will send them information about how we can help. Support staff can request follow-up visits on a referral and check the status of referral requests and processed claims. A wide range of services to get you back on your feet. "Rehabilitation Services (Physical, Occupational, Speech Therapy) are essential to a full recovery.". If you are new, please feel free to fill out these intake forms before our first session.