Northern Arizona Rehabilitation and Fitness: Patient Information

 

NORTHERN ARIZONA REHABILITATION & FITNESS OFFERS 
THE HIGHEST STANDARDS OF REHABILITATION CARE FOR YOU AND YOUR FAMILY

PATIENT FORMS

All forms below are printable PDF files. Please feel free to have these forms filled out prior to your first visit. This will help you save time when coming in for your initial visit and will get you back sooner to see your physical therapist. If you are not able to view the files, you can download Adobe Reader below. If there are any other complications or questions about these forms, please don't hesitate to call our office at
928-649-9726.

Click here for New Patient Intake Form
Click here for Medical History Form
Click here for Cancellation Policy Form
Click here for HIPPA Notice of Privacy Practices
Click here for Patient Information Consent Form
Click here for Financial Policy Form
Click here for Medicare Form
Click here for Patient Satisfaction Survey

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INSURANCE INFORMATION

REFERRAL INFORMATION / PAYMENT

Northern Arizona Rehabilitation & Fitness is a participating provider for almost all insurance companies in our geographical area. Contact our office, at 928-649-9726, if you are unsure of our provider status with your particular insurance company.


Although physical and occupational therapists may treat patients without a written referral, most insurance companies require a prescription from a physician for coverage. Our staff will be happy to verify your insurance coverage on or before your first visit.


We will bill your insurance company for you, but we require deductibles and co-payments to be paid at the second visit of each week.