» Forms :
Forms

Please print and bring the completed paperwork to your first appointment.

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Click Insurance List to see what insurances we participate with

Patient Intake Form

Medical History Form

Financial Policy/Consent

Pain Questionnaire


FOR PATIENTS BEING SEEN FOR WOMEN'S HEALTH:

Patient Intake Form

Medical History Form

Pelvic Floor Medical History

Financial Policy/Consent

Pelvic Floor Consent


For All - no need to print, just read.

Notice of Privacy Practices


 Please arrive 15 minutes prior to your appointment and bring the following:

- Completed Paperwork

- Photo ID

- Insurance Card

- Form of Payment

- Xray/MRI results/operative reports, if available

- Doctor's prescription for physical therapy

- Comfortable clothing

- Knowledge of our location, it can be tricky Map and Directions


Attendance Policy

In an effort to maximize the time your physical therapist spends with you and minimize your wait time, we have made changes to our No-Show and Late Arrival Policies as follows:

No show/late cancellations:

Effective August 1, 2014, we implemented a “no-show” policy which will affect all patients who do not keep their scheduled appointment or who cancel an appointment with less than a 24-hour notice.

  • First occurrence – Patient/parent will be notified of our policy.
  • Second occurrence – A $45.00 no show fee assessment, which will need to be paid prior to your next visit.
  • Third and subsequent occurrences – May result in dismissal from practice and additional $45 no show fee

Late Arrivals:

Patients arriving more than 10 minutes late for a scheduled appointment may be asked to rescheduled.

 


 Insurance:

When your doctor refers you for physical therapy, a prescription is written. Most insurance companies require this prescription to be on file with the therapy office so please bring it with you to your first appointment. Some insurers may require you to have authorization from them before you begin your PT. If necessary, we will obtain this authorization for you once we have your insurance information.



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