Welcome! Thank you for choosing ACTIV Physical Therapy!

What to do for your first PT visit

 

  1. Complete the New Patient Registration
  2. Complete the appropriate Functional Questionnaire
  3. Email the completed forms back to us at info@ACTIVpt.com (or bring them with you to your evaluation)
  4. Email a photo of the front and back of your insurance card to info@ACTIVpt.com (or bring it with you to your evaluation)
  5. Call your insurance company to verify your physical therapy benefits

 

On the day of your appointment

  1. Wear comfortable clothing 
  2. Bring any prescription from your doctor, imaging reports, or other information that may be helpful

 

New Patient Registration
2018PatientRegistration.pdf
Adobe Acrobat document [52.8 KB]
Back Index
For Lower Back and Mid Back
Back Index.pdf
Adobe Acrobat document [76.4 KB]
Quick DASH
For Shoulder, Elbow, Wrist, Hand, Arm
Quick Dash.pdf
Adobe Acrobat document [76.7 KB]
LEFS (Lower Extremity Functional Score)
For Foot, Ankle, Knee, Hip, Legs
LEFS.pdf
Adobe Acrobat document [79.2 KB]
Neck Index
For Neck, Upper Back, Shoulder blade region
Neck Index.pdf
Adobe Acrobat document [76.4 KB]

What to do for your first Acupuncture appointment

  1. Read, sign and print the "Informed Consent to Treat" form
  2. Read, sign and print the "Disclosure of Protected Health Information" form
  3. Review the "Privacy Practices and What is Acupuncture?" forms
  4. Bring the two signed forms to your first Acupuncture appointment
DisclosureProtectedHealthInfo.pdf
Adobe Acrobat document [30.4 KB]
Privacy Practices.pdf
Adobe Acrobat document [50.9 KB]
What is Acupuncture?.pdf
Adobe Acrobat document [43.0 KB]
InformConsent.pdf
Adobe Acrobat document [130.1 KB]

Policies

Financial Responsibility
Financial Responsibility.pdf
Adobe Acrobat document [67.6 KB]
Notice of Protected Health Information Practices
ACTIV-HIPPA-PHI-POLICY.pdf
Adobe Acrobat document [40.4 KB]

Insurance Overview

 

ACTIV Physical Therapy is In Network with Medical Mutual, Anthem and MultiPlan. 

We also accept Medicare. 

 

If you have United Healthcare, Aetna, or Cigna, please check your insurance card to see if your plan is participating in MultiPlan. There will be a logo on your card. MultiPlan functions between us, the provider, and your insurance company. Since we are part of the MultiPlan Network, this is to your benefit as a patient, if your plan is participating. Essentially, MultiPlan discounts patient responsibility. The discount is not quite the price of In Network, but definitely helps with the Out of Network cost.   

 

If you are out of network and your plan is not participating in MultiPlan, we offer a facility discount of 35% to help offset additional patient responsibility. 

 

Please contact our office directly for additional questions regarding insurance, as each plan varies. 

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