Patient Paperwork

You can save time in the office by printing and completing the following paperwork prior to your appointment. Click the giant PDF button labeled "Patient Intake."

 

Complete the Patient Intake if any of the following apply.

- I am a new Physical Therapy Patient.

- I am a new Chiropractic Patient.

- I am a previous patient but I have not been in the office in over a year.

- I am a previous patient and I need to update my insurance and/or health history.

Diabetic Footwear

We can take care of all of the following for you, but you can expedite the process by completing it yourself.

The following are required from your Physician (MD/DO).  Other provider types are not qualified by Medicare to provide the referral (i.e. Nurse Practitioner, Physician Assistant).

- Certificate of Medical Necessity

- Documentation from your Physician showing that they are managing the treatment of your Diabetic condition.  This documentation is typically referred to as a SOAP note.  Your most recent visit to your Physician regarding your Diabetes must have been within the last 6 months.

These documents can be faxed to our office at 740-266-6394.

Wintersville - 860 Main St (Kroger Plaza) 

(740) 264-9500

 

Toronto - 1007 Franklin St (Court House)

(740) 537-9440

©2018 by Physical Therapy Associates