Get the free PHYSICAL THERAPY REFERRAL FORM - pugetsound.edu

University of Puget Sound Physical Therapy offers PT appointments during Fall Semester between Labor Day and Thanksgiving on Tuesdays and Thursdays.

How to fill out physical therapy referral form

How to fill out a physical therapy referral form:

1. Start by obtaining the form: You can typically get a physical therapy referral form from your primary care doctor, orthopedic specialist, or any healthcare professional who believes you would benefit from physical therapy.
2. Fill out your personal information: The form will require you to provide your full name, date of birth, gender, address, contact information, and insurance details. Make sure to double-check the accuracy of this information before submitting the form.
3. State the reason for the referral: Indicate the specific condition or injury that necessitates physical therapy. You might be asked to provide a brief description of your symptoms or the purpose of the referral.
4. Specify any pertinent medical history: It's essential to include any relevant medical history that might impact your physical therapy treatment. This could include previous surgeries, medications you are currently taking, and any chronic conditions you have.
5. Mention any specific requests or goals: If you have any specific expectations or goals for your physical therapy treatment, you can use this section to communicate them. For example, if you have a particular area of focus or if you require specific techniques, make sure to mention them here.
6. Obtain necessary signatures: Some forms may require your signature and the signature of your referring healthcare provider. If this is the case, make sure both signatures are obtained before submitting the form.

Who needs a physical therapy referral form?

1. Patients with musculoskeletal injuries: Individuals who have experienced injuries or conditions affecting their muscles, bones, ligaments, or tendons may need a physical therapy referral form. This can include fractures, sprains, strains, or joint-related issues.
2. Post-operative patients: After certain surgeries, such as joint replacements or repair procedures, physical therapy may be necessary to aid in the recovery process. A referral form is often required to initiate these post-operative therapy sessions.
3. Individuals with chronic pain or disabilities: Those living with chronic pain conditions or long-term disabilities can benefit from physical therapy. A referral form helps ensure that they receive the necessary treatment to improve their daily lives.
4. Patients with mobility or balance issues: People experiencing difficulties with mobility or balance, whether due to aging, neurological conditions, or other factors, may require physical therapy. A referral form helps connect them to appropriate services.
5. Athletes: Athletes who sustain sports-related injuries may need to undergo physical therapy to regain strength, flexibility, and overall function. A referral form assists in initiating this specialized treatment.

Remember, the need for a physical therapy referral form may vary depending on your location and healthcare system. It is essential to consult with your healthcare provider to determine the specific requirements in your situation.

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What is physical therapy referral form?

Physical therapy referral form is a document used to refer a patient to a physical therapist for treatment.

Who is required to file physical therapy referral form?

Physical therapy referral form is typically filled out by a healthcare provider such as a doctor or nurse practitioner.

How to fill out physical therapy referral form?

To fill out a physical therapy referral form, the patient's information, reason for referral, and any relevant medical history must be provided.

What is the purpose of physical therapy referral form?

The purpose of a physical therapy referral form is to authorize and recommend treatment by a physical therapist.

What information must be reported on physical therapy referral form?

Information such as patient's name, contact information, insurance details, referring provider information, and reason for referral must be reported on the form.