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NEW PATIENT FORMS
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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. You need Acrobat Reader to open these forms. Click here for a free download. 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 Financial Policy Appointment Policy History (2 pages) Authorization HOME NEW PATIENT FORMS PROFESSIONAL STAFF INSURANCE AFFILIATIONS PRIVACY STATEMENT AQUA ORTHOPEDIC & SPORTS HAND INTERVENTIONS SPORTS ENHANCEMENT FIND US CONTACT US Copyright © 2006 Peak
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