Insurance Information:
Treatment is “fee for service.” This means that the patient is responsible for all costs at the time of treatment. If you wish to submit a claim to your insurance company for reimbursement, I will provide you with appropriate codes and billing information. You may download an “Insurance Benefit Worksheet” to help you with the process. Please understand that your insurance may not cover your physical therapy treatments, and prior approval does not guarantee coverage. In the state of Florida, even if authorization is not needed, most insurance companies want some kind of documentation from your doctor, usually a prescription. I can only treat an undiagnosed condition for 20 days (consecutive calendar days) without a prescription, and I really prefer to work with your physician, so having a physician of record that is familiar with your condition is the optimal treatment scenario.

New Patient Forms
Medical History
Informed Consent
HIPPA signature form
Signing this form only states that you have been given the opportunity to read our policy, which is available for down load at the link on the main page.

Forms For Pelvic Pain patients or those with Bowel or Bladder Problems
(You must fill out these in addition to the New Patient Forms)
Voiding Diary - please fill these out on 3 consecutive days prior to your appointment; try to choose typical days (2 work days and 1 weekend).
Voiding Diary Instructions
Health Screen Questionnaire