We realize that you have a choice in physical therapy facilities and we appreciate that you have chosen us. We are providing our new patient forms for your convenience. You are welcome to complete and print out these forms prior to your appointment. We look forward to helping you achieve your health care goals.
- Patient Information Form
- Medical History Form
- Notice of Privacy Practices (For viewing purposes only)
Additionally, please fill out one of the following forms according to the condition you will be treated for.
As a courtesy, our staff will contact your insurance carrier and verify your physical therapy benefits. We will work with you to ensure that your insurance carrier receives all the documentation needed to process your claim. However, our relationship is with you as our patient and not with your insurance carrier. The information given to us by your carrier is never a guarantee of benefit coverage. Claims are only guaranteed at the time of processing. As a patient you will be receiving services and will have the final responsibility to pay for those services.
If your insurer fails to pay the full amount of our bill for services, you will be required to pay the difference in addition to your deductible and/or co-payment amount.
Please be advised that some policies require prior authorization for each visit that may be time sensitive. We will make every effort to track your authorized visits accurately, but we will not be held responsible if you exceed your visits. As our patient it is your responsibility to know your authorized number of visits and expiration date, and you will be held responsible for payment for treatments that exceeded your benefit.
New York State Law requires a written prescription from your physician for physical therapy treatment. These must be updated periodically according to your insurance carrier’s guidelines. We will notify you when a new prescription is needed. It is your responsibility as the patient to contact your physician to obtain an updated prescription to continue with physical therapy.
Co-payments required by your insurance carrier, co-insurance or annual deductible amounts will be due at the time of service. You will receive a personal statement and bill (where applicable) approximately each month so that you can monitor your charges and your carriers payments. Please be advised our bill is due in full when received.
Late Cancellation/No Show Policy
If you are unable to attend your scheduled appointment, we require a 24 hour notice. A $30 fee will be imposed for appointments non-attended or canceled with insufficient notice. This fee will not be billed to your insurance carrier.