 |
Forms
Health Questionnaire
Vestibular Questionnaire
Patient Registration Form
Steps for our new patients...
1. Get a referral/ prescription from your doctor. Your doctor can either give the form to you to bring with you on your first visit, or your doctor can fax it to our office at 203-776-4989.
2. Call our office to schedule an appointment. New Haven phone: 203-752-7878 and Branford phone: 203-483-5858.
3. If you will be coming in for physical or occupational therapy due to an auto accident, please have the following information available:
- name of YOUR auto insurance company.
- whether or not you have medical coverage under your auto policy. If you do, how much. If you do not, please get a letter of no med pay to our office by the time of your first appointment.
- the name of your adjustor and a phone number
- claim number
- the date of the accident.
- the name of your attorney and phone number.
4. If you will be coming in for physical or occupational therapy due to a workers compensation injury, please provide us with the following information:
- the name of your workers compensation insurance
- claim number
- the name of your adjustor and his/ her phone number
- date of the injury
- place of employment when the accident occurred
5. Once we have you scheduled for an appointment, please print the following forms, complete them prior to your appointment day and time and bring them with you on your first visit along with your insurance cards and a driver's license.
If you have any questions please call us at 203 752 7878.
|
 |
