New Patient Forms

Please download and complete the following forms and bring them with you to your first appointment.

New Patient Registration

Patient Consent

Patient Health History 

Health, Pain & Activity Inventory

Now serving you at in Chapel Hill and Durham!

Please visit our Locations page for specific instructions on where to find us!

Do you take insurance?

We are in network with most major health insurances. We will call to verify your insurance coverage prior to your first appointment once you have provided your plan information.

Do I need a referral?

North Carolina is a DIRECT ACCESS state for physical therapy.  This means that you do NOT need a physician referral to begin treatment with a physical therapist.

Medicare and any Medicare Advantage/Medicare Replacement plans will require that a physician sign the PT plan of care if you do not have a referral.  Typically, your primary care physician, if you see them on a regular basis, will take care of this when we fax a copy of your evaluation to them.

If you have a HMO insurance plan, your insurance may require you to have a physician referral in order to cover your physical therapy visits.

Our FAX number for referrals is 919-933-1150.

What insurance plans do you accept?

We are an in-network provider for:

• • • Medicare, and most Medicare Replacement Plans (Physician Sign Off or Referral Required)
    • Aetna
    • Blue Cross Blue Shield – Federal and State Health plan members. Blue Advantage, Blue Options, Blue Select and Blue Medicare HMO and PPO. (Not Blue Value nor Blue Local)
    • Cigna
    • Coventry
    • United Health Care (Optum HealthCare, UMR, Oxford Health Plan)

If your insurance carrier is not listed above, please call us. We continuously strive to become an in-network provider with local plans that support fair pay. We will be happy to verify your benefits and provide an estimated cost per visit when PT is provided by an out-of-network provider.  We find that your cost to see an out-of-network PT is often similar or identical to your cost to see an in-network PT.

My Insurance is Humana, can I come to your clinic?

Though we are considered an out-of-network provider, you can still come to our clinic if you have a PPO plan. Fortunately, your out of pocket cost is most often the same as if you saw an in-network physical therapist!

If you have a Humana HMO plan, this plan unfortunately has NO out of network coverage. You may still be seen at our clinic as a self-pay client.

If you are experiencing financial hardship, please contact us at [email protected].

I don’t have insurance OR I don’t want to use my insurance, can I come to your clinic?

If you do not have health insurance but are in need of a treatment, you may come directly to us.

Our self-pay rates for service are:

• • • Initial consultation: $150
    • Follow-up visits; $100
    • Re-evaluation $125

If you are experiencing financial hardship, please contact us at [email protected].

My condition is a result of an auto accident, what should I do?

If you’ve been in an automobile accident, you must  inform us so we can confirm whether we can or cannot accept assignment from the third party payer. Otherwise we will submit your medical claims through your health insurance company or accept out of pocket payments. It will be your responsibility to seek reimbursements from your auto insurance carrier or any legal proceedings you may have pending.