Info For New Patients

NEW PATIENT INFORMATION

Thank you for choosing Montgomery Physical Therapy for your rehabilitation care needs! We want your first visit with us to be an excellent one, giving you all the information that you need and want to achieve you and your physician’s goals. Please take the time to go over our “frequently asked questions” about your first visit and do not hesitate to give us a call should you want or need more info. These questions include “How do I dress for my therapy?”, “What do I bring with me?”, and many others. Also, so that we can assist you quickly during your first evaluation visit, please print and complete our patient forms and bring them with you, as well as your driver’s license or ID and your insurance card(s) so that we may have copies for our file. Again, thank you for scheduling with us and we look forward to treating you!

PATIENT FORMS

Please return the first 2 forms (listed and linked below) on the day of your initial evaluation, or fax them to us ahead of time to 936.597.8914 (if your appointment is at the Montgomery office) or 936-756-7480 (if your appointment is at the Conroe office). Don't forget to bring your insurance cards and identification as well! Please arrive 15 minutes prior to your scheduled appointment time so that you may meet with our Patient Coordinator. We look forward to seeing you!

1.  Patient Information and Medical History form

Please print, fill out, and return these forms to us the day of your visit or by fax to 936.597.8914. These pages gather demographic information as well as medical information regarding your visit.

 Patient Information and Medical History

2. Consent and Authorization

Please print, fill out, and return these forms to us the day of your visit or by fax to 936.597.8914. This form gives us consent to treat you, authorizes us to bill your insurance company(ies), lets us know if you are receiving home health treatment (Medicare only), allows your insurance company to pay us directly, and acknowledges that you have received our HIPAA Privacy Notice (included below and is yours to print and keep).

Consent to Treat Consent to Treat

3. HIPAA Privacy Notice

Yours to keep! This notice advises how your protected health information (PHI) is used within our office.

 HIPPA Policy

Our New Patient Booklet is also available online for viewing and/or printing.

 New Patient Booklet