New & Returning Patients - (choose 1 type of Patient form below that applies to you)
Standard Patient Forms (Commercial Insurance & Self Pay)
Women's Health Only - Medicare (Pelvic Floor)
***Please bring a Current Medication List - if applicable***
Dry Needling Consent Form (if applicable)
Patient Attestation 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 4 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 BELOW
What is the difference between a Physician Referral and a Prescription?
Some insurances require a physician's referral for coverage of Physical Therapy. Insurances that require a "Referral" are the responsibility of the patient or if a minor that of the parent or legal guardian. 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 care physician's office if you have any questions.