If you're a new patient, please print the New Patient Forms that best describes your problem and bring the completed forms and your Physician Referral/Prescription ** to your first appointment.
- New Patient Forms - Female Pelvic
- New Patient Forms - Male Pelvic
- New Patient Forms - Hip (Male or Female)
- New Patient Forms - Back (Male or Female)
Notice of Privacy Practices - this is for you to review - you do not need to bring this to your appt
Our Office requires a prescription at your first visit.
Although the Texas State Physical Therapy Licensing Board does allow for a short-term treatment by a therapist without prescription (10 consecutive calendar business days), we require a prescription for your first visit in order to provide uninterrupted care for the course of your treatment.
Additional Forms
Blank Prescription / Referral Form
Authorization to Release Medical Information
Note: To download Adobe Acrobat Reader for free, click here.
We are in network with many insurance companies, but not all. Please contact our office to see if we are in network with yours.
Good Faith Estimate Notice
You have the right to receive a “Good Faith Estimate” explaining how much your health care will cost.
Under the law, Health care providers need to give patients who do not have insurance or who are not using insurance an estimate of the bill for medical items and services. This is called a Good Faith Estimate.
You have the right to receive a Good Faith Estimate for total expected cost of any health care items or services.
The Good Faith Estimate shows the total expected cost of any non-emergency items or services and equipment.
You may request a Good Faith Estimate in advance of an already scheduled health care service or item, or before scheduling an item or service.
If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
Make sure to save a copy or picture of your Good Faith Estimate.
For questions or more information about your right to a Good Faith Estimate or the dispute process, visit www.cms.gov/nosurprises or call 1-800-985-3059.