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OFFICE USE: EVAL DATE ___ THERAPIST ___ ACCOUNT # ___ SP Agr Ins card MC Cap Tool Rx: Rbd gen other PT no RXREFERRAL INFORMATION1. Which best describes how you decided to receive your care at Rebound?
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How to fill out direct access physical formrapy

How to fill out direct access physical formrapy
01
Obtain the direct access physical therapy form from the physical therapy clinic or download it from their website.
02
Fill out all personal information including name, address, contact number, and insurance information.
03
Provide details about your medical history, current condition, and reason for seeking physical therapy services.
04
Sign and date the form to verify the accuracy of the information provided.
05
Submit the completed form to the physical therapy clinic either in person or via email/fax.
Who needs direct access physical formrapy?
01
Individuals who have a musculoskeletal injury or condition that can benefit from physical therapy.
02
Those who prefer to bypass the need for a physician's referral to access physical therapy services directly.
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