Prior to your first visit please print out and complete the patient intake paperwork. Please select the paperwork according to your primary insurance or payment method: Private Insurance, Medicare, Workers Compensation, or Non-Insurance (Private Payment).

Private Insurance

Please print the required paperwork and fill out prior to your appointment. Upon arrival the front office will fill out the specific insurance sections of the paperwork and have you sign the patient information sheet. You will also be given some additional paperwork that can only be completed in our office.

• Insurance Patient Paperwork*
   

Medicare

Medicare patients should fill out the private insurance paperwork packet. Additional Medicare specific paperwork will be required when during your first visit.

• Medicare Patient Paperwork*
   

Workers Compensation

Please fill out the workers compensation packet prior to your appointment. You may also be given some additional paperwork that can only be completed in our office.

• Workers Comp Paperwork*
   

Non-Insurance Paperwork for Private Pay Physical Therapy and Wellness Services

All patients and clients who will be receiving Physical Therapy or other wellness services on a private pay basis are required to fill out the following paperwork.

• Non-Insurance Private Pay Paperwork*
   

* These documents are .pdf (Portable Document Format) files and require Adobe Acrobat Reader. If you need to download the reader please use the link below.

To schedule, call LPT at 925-284-6150 today.

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