Paperwork Required for First Visit
New and Returning Patients - Please print and complete forms below:
Step 1
New & Returning Patients Only - Please print and complete the forms below:
Medicare & Returning Medicare Patients Only (Returning patients complete if last visit to our facility is more than 60 days)
Step 2
Choose what best applies to you
Arm, Shoulder and Hands Assessment
Shoulder Post Operative Assessment
Step 3
Self Referral Form (if applicable)
Direct Access - Did you know that per the state of Virginia direct access guidelines, a Physical Therapist may treat patients for up to 2 weeks without MD referral. However, most, if not all, health insurance companies require a physician referral from the first date of service for reimbursement purposes.
For this reason, it is recommended that every patient obtain a physician prescription and/or referral as required (referrals are required for some Aetna and all MAMSI covered patients, e.g.) and bring this with them to the first PT appointment. Please also bring a picture ID and your insurance card for verification purposes.
If you have obtained paperwork from our web-site, please bring the completed forms with you as well. If not, we ask that you arrive 15-20 minutes early to complete the admission paperwork process.
Upon your first visit, please bring all of the following:
- New patient information and Assessment Forms
- Physician Referral and /or Prescription or a Completed Self Referral Form
- Insurance card & Identification
- Comfortable clothing and sneakers
General Information:
HIPAA and Patient Bill of Rights
What is the difference between a Physician Referral and a Prescription?
Some insurances require a physician's referral for coverage of Physical Therapy. If you have a HMO insurance card and a primary care physician you most likely will need a referral. Please call your insurance company and/or contact your primary car physician's office if you have any questions.
