contact us

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123 Street Avenue, City Town, 99999

(123) 555-6789

email@address.com

 

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Forms

FORMS

Please download, print, and fill out the appropriate forms prior to your first appointment. Call (512) 852-8434 with any questions regarding physical therapy intake forms or questions regarding Women’s Health and Pelvic Health intake form.

CHOOSE RELATED FORM FOR PERTINENT BODY PART

ARM, SHOULDER AND HAND DISABILITIES

BACK INDEX

LOWER EXTREMITY

NECK INDEX

ADDITIONAL FORMS REQUIRED FOR INSURANCE PURPOSES

MEDICARE PATIENTS

ABN FORM

UNITED PATIENTS 

Only fill out if you have United Healthcare insurance

PATIENT SUMMARY FORM

INSURANCE AND DISCOUNTS

We extend a 10% discount if you are paying Cash Out of Pocket, have high deductible insurance plans or if you are opting out of your HMO (please see Cash Discounts below). We are an in-network provider with the insurances listed below. We also accept Workers Compensation and Letters of Protection for automobile accidents. Please see the “Billing FAQ’s” to see if your insurance requires a referral.

If you do not see your insurance company listed, please contact your carrier or
Your Personal Best. There is a good chance that your insurance will cover your office visit with Out-of-Network Benefits.

We also offer a programs for cash paying clients. CLICK HERE for more information.

We encourage all of our patients to be aware of their health benefits. If you have questions regarding your insurance plan before you begin therapy, please call us at (512) 852-8434. Join our mailing list for special offers and coupons, SIGN UP here.