Paperwork Required for First Visit

New and Returning Patients - Please complete forms below:

 

Step 1

New & Returning Patients Only (Returning patients complete if last visit to our facility was more than 60 days)

Online Form Standard

Medicare & Returning Medicare Patients Only (Returning patients complete if last visit to our facility was more than 60 days)

Online Form Medicare

Step 2

Choose what best applies to you

Arm, Shoulder and Hands Assessment Shoulder Post Operative Assessment Neck Assessment Lower Extremities Assessment Lumbar Spine Assessment

Step 3

Self Referral Form (if applicable)

Download PDF

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.