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Outpatient Rehabilitation Admission Forms

Thank you for scheduling your outpatient rehabilitation appointment with Casa Colina Hospital and Centers for Healthcare. Please complete the admission forms below in advance and bring the completed forms to your first appointment to expedite your admission process. Please do not attempt to submit admission forms via email.

Admission Forms English

Admission Forms Spanish

If you have questions filling out your forms, please call 909/596-7733, ext. 3500 if your appointment is at our Pomona campus, or 626/334-8735 if your appointment is at our Azusa Center. We look forward to seeing you, and thank you for trusting us with your healthcare needs.

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