Schedule A Physical Therapy Appointment

Please have the following information ready when you call to make an appointment:





Your name
Daytime phone number
Date of birth
Primary Care Physician (PCP)
Insurance Employer (cardholder)
Referring Physician
Body Part
Insurance Company (primary)
Contract number, group number, and phone number on your insurance card
Insurance Company (secondary)
Insurance Company (primary)

To help us complete your chart, please download the introduction information for your insurance and the questionnaire for your injury. Please bring completed forms with you to your appointment.

Insurances Accepted

 

Cigna HMO (referral required)
Cigna PPO
Cofinity
Connecticut General PPO
DMC PSO/PPPC
Great West/One Health
HAP HMO (referral required)
HAP/PHP (CIGNA)
HRM - CBC
Medicare
Medicare Advantage


Medicare Plus Blue
Medicaid (straight)
Multiplan
One Health
Palmetto GBA
PHCS
PHS
Priority Health
Teamsters PPOM
Tri-Care
UMWA Medicare retiree
United Healthcare
Workers Comp





Please download our forms

Please download our forms and complete for a faster visit.

Medicare Infomation

Download our PDF form

Private Insurance/ WC /Auto

Download our PDF form

Ankle Questionnaire

Download our PDF form

Elbow Questionnaire

Download our PDF form

Hip Questionnaire

Download our PDF form

Knee Questionnaire

Download our PDF form

Lower Back Questionnaire

Download our PDF form

Neck Questionnaire

Download our PDF form

Wrist Questionnaire

Download our PDF form

Shoulder Questionnaire

Download our PDF form