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Below you will find the
forms you will need for
registration at Ramsey
Rehab. We know you are
very busy and appreciate
your taking the time to
fill them out in
advance. Thank you for
helping us to speed up
the new patient
registration process for
all people scheduled for
an appointment at Ramsey
Rehab. Select the
appropriate form, print
it, fill out the
appropriate information
and bring it with you
for your initial
evaluation. All
evaluations are
scheduled.
To
be added to the Ramsey
Rehab Newsletter mailing
list send an email to
kevin@ramseyrehab.com
with the word
"Newsletter" in the
subject line.
ANY FIELD YOU DO NOT
CHOOSE TO FILL IN ONLINE
CAN BE PROVIDED
ON YOUR FIRST VISIT TO
RAMSEY REHAB. ON ALL
FORMS, ALL AREAS
HIGHLIGHTED IN BLUE ARE
MANDATORY.
Patient Registration
Form
(printable & online)
Patient Missed
Appointment Policy
(printable & online)
HIPAA Consent Form
(printable & online)
Workers Compensation
Insurance Form
(printable &online)
Motor Vehicle Accident
Insurance Form
(printable & online)
No
Health Insurance Form
(printable & online)
.gif) Notice of Health
Provider Lien Form
(printable only)
Things to remember:
1) Please arrive 5
minutes early if the
forms are completed.
2) Please bring any
information your
physician has given
you for us.
3) Please bring
your insurance
card(s) and any
additional
information that you
feel would assist us
in helping you.
4) If you are being
sent to us by anyone
other than your
Primary Care
Physician (PCP) then
please call your PCP
and request a
referral for
Physical Therapy
(PT)
5) If your
insurance requires
you to notify them
before seeing us-
please call them.
6) If your Health
Insurance that you
are using to bill
for your Physical
Therapy has a
co-pay, you
should bring in
payment at the time
of your visit.
We accept cash,
personal check,
MasterCard and Visa.
7) Any injuries
below the waist-
bring shorts (if
able) if above the
waist- bring a
T-shirt
8)
ANY FIELD YOU DO NOT
CHOOSE TO FILL IN
ONLINE CAN BE
PROVIDED ON YOUR
FIRST VISIT TO
RAMSEY REHAB. ALL
FIELDS HIGHLIGHTED
IN BLUE ARE
MANDATORY ON ONLINE
FORMS.
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