Forms

Click on the following links to download your paperwork for your first visit.

1. New Patient Forms-  Commercial Insurance, Medicare/Medicare Advantage,  Workers’ Compensation, and Motor Vehicle Accident:

2. Notice of Privacy Practices: This is for your reading prior to signing and agreeing to HBPT Policies.  You do not need to print this unless you want to read it and keep it for yourself.

3. Progress Report Care Connection Forms:  Allison will ask you to print and fill this out when it is time to complete a progress report for your insurance or Physical Therapy standards of practice.

4. Medical Release Form: -This only needs to be completed when requesting records from HBPT or having HBPT request records from a practitioner other than your referring practitioner (MD, DO, NP, PA, ND, etc).  Complete and return to HBPT via fax, by mail, or in person.

5. Time of Service/Private Pay Discount Policy:  If we are not billing insurance and you are paying privately for your physical therapy visits, please print and complete this form and bring with you to your first visit.

Notice of Nondiscrimination and Accessibility Rights

Click here to read what to expect at your first visit.