To help save time at your visit to Peak Physical Therapy, P.C.we suggest that you print out the applicable forms from the list below and bring the completed form with you.
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If your therapy is covered under NO FAULT INSURANCE, CLICK HERE . You find the following 7 forms:
Patient Information/No-Fault
Appointment Policy
Financial Policy
New York Motor Vehicle No-Fault Insurance Law Assignment of Benefits
History (2 pages)
Authorization
If your therapy is covered under WORKMAN'S COMPENSATION, CLICK HERE. You find the following 5 forms:
Patient Information/Workers' Compensation
Appointment Policy
History (2 pages)
Authorization
If your therapy is covered under MEDICARE, CLICK HERE. You find the following 6 forms:
Patient Information/Medicare
Appointment Policy
Financial Policy
History (2 pages)
Authorization
PLUS THE APPROPRIATE ONE BELOW:
If your therapy is covered under:
THE EMPIRE PLAN (NYS GOVERNMENT PLAN)
ORANGE ULSTER SCHOOL DISTRICT
OXFORD HEALTH PLAN
UNITED HEALTHCARE POWER AUTHORITY
UNITED HEALTHCARE CH ENERGY OR CENTRAL HUDSON
You find the following forms (click on the correct link below):
ALL PATIENTS : History and Authorization
PLUS THE APPROPRIATE ONE BELOW:
If your therapy is NOT covered under any of the insurance companies mentioned above, CLICK HERE. You find the following 8 forms:
Patient Information
Health Survey
Health Questions
Financial Policy
Appointment Policy
History (2 pages)
Authorization
