Attention Reminder
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New Client Registration
Please fill out this two page document prior to your appointment.
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Financial Policy
Please read, sign and bring this document with you to your initial appointment.
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Health History
Please make sure to fill this document out to the best of your ability and bring it with you to your appointment. Your therapist will review this document with you at the time of your initial appointment.
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Work Comp Insurance Only
If we will be seeing you due to a work related injury and we will also be billing your worker's compensation insurance carrier, please fill out and bring this form with you to your appointment. Please do not fill out the private health insurance form or the motor vehicle accident form if we are not going to be billing them.
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MVA/PIP ONLY
If we will be seeing you due to a motor vehicle accident related injury and we will also be billing your motor vehicle insurance carrier (PIP - personal injury protection), please fill out and bring this form with you to your appointment. Please do not fill out the private health insurance form or the work comp insurance form if we are not going to be billing them.
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Private Health Insurance ONLY
If we will be seeing you and we will also be billing your private health insurance carrier, please fill out and bring this form with you to your appointment. Please do not fill out the work comp insurance form or the motor vehicle accident form if we are not going to be billing them.
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