Coverage for Your Medical Needs

Basic demographics and insurance information for all patients.

Please bring the Physician note or Referral signed by the physician with you on your first visit. It is possible that we may be unable to see you without a referral. You can print this Physician Referral Form and have the physician sign it.

Form for Medicare patients.                                                    

If you are having a problem in one of the body regions listed in the column, click on that region, print off, and fill out the form and bring it with you. Please do this within 24 hours prior to your appointment.

Complete la forma apropiada basada en la localización del problema.

If you are having a problem in one of the body regions listed in the column, click on that region, print off, and fill out the form and bring it with you. Please do this within 24 hours prior to your appointment.

Complete la forma apropiada basada en la localización del problema.

Patient Registration

We know you have a choice when it comes to your physical therapy care, and we have a passion to serve
you and meet your physical therapy needs. 
On our end:

  • Provide free-screening appointments

  • Obtain a referral for physical therapy from your doctor if one is needed

  • Complete insurance pre-certifications for you

  • Provide easy access to physical therapy care and convenience of scheduling

  • Ensure quality and quantity of time with our therapists

  • Engage in ongoing communication with physicians and third party payers, or insurance providers, or your insurance company.

We encourage you to click on the “Patient Registration Form” and after completing the registration form,  go to the Health Questionnaire form. Please fill out both forms for your first visit .

Phone (770) 962-4043

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©2019 by Primacare Physical Therapy.