 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. ► Patient Missed Appointment Policy (printable) ► Patient Missed Appointment Policy (online) The HIPAA Consent Form is required for all cases: Select and print the form below
► HIPAA Consent Form (printable) ► HIPAA Consent Form (online) If you were injured at work: Select and print the forms below ► Patient Registration Form (printable) ► Patient Registration Form (online) ► Workers Compensation Insurance Form (printable) ► Workers Compensation Insurance Form (online) If you were injured in a car accident: Select and print the forms below ► Patient Registration Form (printable) ► Patient Registration Form (online) ► Motor Vehicle Accident Insurance Form (printable) ► Motor Vehicle Accident Insurance Form (online) ► Notice of Health Provider Lien Form If you have no insurance: Select and print the form below ► No Health Insurance Form (printable) ► No Health Insurance Form (online) For all other reasons or occurrences: Select and print the form below ► Patient Registration Form (printable) ► Patient Registration Form (online) 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. |