We have been experiencing intermittent phone issues and apologize for the inconvenience. We are working with our carrier to resolve, but if you are unable to reach us by phone you can email at FD@lafayettept.com

Patient Forms & Paperwork


Physical Therapy

If a private insurance is your primary insurance provider (such as Blue Cross, Blue Shield, Healthnet, Aetna, etc.), print and complete this form. Please view our Insurance section for further assistance. This is not for Workers’ Compensation, Medicare, etc. please see below for those forms.
PRIVATE INSURANCE FORM

If Medicare is your primary insurance provider, print and complete this form.
MEDICARE FORM

If you seeking care with an open claim for a Motor Vehicle incident, print and complete this form.
MOTOR VEHICLE FORM

If you are currently seeking care with an open/pending Worker’s Compensation case, print and complete this form.
WORKERS’ COMP FORM

If you are interested in receiving Physical Therapy on a private pay basis, print and complete this form.
PRIVATE PAY FORM

 

Wellness

If you are interested in receiving our massage therapy services, print and complete this form.
MASSAGE NEW CLIENT FORM

If you are interested in participating in any of our wellness programs, print and complete this form.
WELLNESS NEW CLIENT FORM

If you are interested in receiving our AlterG services, print and complete this form.
ALTERG® NEW CLIENT FORM

Contact Information

Lafayette Physical Therapy 925-284-6150

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