Experience the Difference

Patient Forms

Insurance companies continue to require the patient to provide more documentation during their initial visit. Each insurance payer requests different items and this page is designed to help you fill out the proper paperwork required by your insurance.

Please answer the following questions below so we can provide you with the information you need for your initial visit with us at PRO-PT.

Please be sure to download all files that appear. Thank you for your time and patience.

Were you referred for balance or fall prevention?

Were you referred for dizziness or vertigo?

Please look on your insurance card and tell us who your PRIMARY insurance is

(Choose more than one if needed) Please tell us why we are seeing you?

Neck or Numbness or tingling in arm
Low-Back, Mid-Back or Numbness or tingling in legs
Shoulder
Elbow, Wrist, or Hand
Hip or Knee
Foot or Ankle
Balance & Falls
Dizziness or Vertigo

Click Here To Download Documents

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