PATIENT FORMS:
Please print and fill out in BLACK ink the following patient forms and bring them with you to your first visit. If you have all of your paperwork filled out & with you, we ask that you be here 15 minutes prior to your appointment time so we can go over forms, give you any additional paperwork you may need to fill out, collect copays if applicable, and enter you into the computer system. If you do not have the forms, we ask that you arrive 30 minutes prior to your appointment time to fill out the necessary paperwork.
Thank you!
Stanwood Camano Physical Therapy
PATIENT RESPONSIBILITY:
INSURANCE: It is your responsibility, as the patient, to know what your insurance limitations are; deductibles, copays, and restrictions. If your insurance requires pre-authorization, you are responsible for assuring that you have the proper authorization from your insurance before being seen. NOT all providers are "preferred providers" on your insurance and if you are seen by one of these, you will be responsible for the amount not covered by your insurance. You are responsible for all costs not covered by your insurance company, copays, and cancellation or no show fees.
CANCELLATION/NO SHOW POLICY: We require a 24 hour notice on all cancelled appointments in order to avoid up to a $25 fee that is billed to you, not your insurance company. You will also be charged if you do not show up for your appointment. It is our company policy that after 3 no shows or same day cancels to put you on a "same day call list" instead of booking appointments in advance. If you have any questions about this policy, please feel free to ask.
PRINT OFF THE 3 FORMS BELOW:
1) What To Expect - This form is yours to keep.
2) Patient Information Form - Please fill out completely. If you have had physical therapy in the last year, please note where asked because some insurances only allow for a certain amount of therapy.
3) Patient Consent, Rights & Responsibilities - Please read and sign. If you would like a copy, please let us know when you check in.
TAOS- You do not need to fill this out unless asked to do so.