Get Pasadena Physical Therapy

Filling out the Pasadena Physical Therapy online form is an important step in beginning your treatment. This guide provides a detailed overview of each section of the form to ensure a smooth and successful submission process.

Follow the steps to complete the Pasadena Physical Therapy online form.

1. Click ‘Get Form’ button to access the form and open it in the editor.
2. Begin by entering your personal information in the Patient Name, Date of Birth, and Home Address fields. Ensure that all data is accurate and clearly printed.
3. Provide your contact information by filling out the phone number fields (home, work, and cell) and your email address. This information is crucial for communication.
4. Complete the Driver’s License # and Social Security # fields, followed by indicating your sex by selecting M or F.
5. Fill in your Emergency Contact details, including their name and phone number.
6. Input the name of your Referring Physician and the Date of Last Medical Visit.
7. Describe your Diagnosis and include the Prescription Frequency & Duration as dictated by your doctor. Indicate if it is the same as the referring doctor’s by selecting Yes or No.
8. Provide details about your Primary Care Physician and how you were referred to Pasadena Physical Therapy.
9. Indicate if you have received physical therapy services earlier this calendar year by selecting Yes or No, and specify the number of visits and the location of services if applicable.
10. If applicable, indicate if an attorney is involved, including their name and phone number.
11. Select the type of injury you are claiming: Auto Injury, Work Injury, or Personal Injury, along with the Date of Injury.
12. For the insurance section, fill in your Primary Insurance details including the name of the insurance company, Customer Service phone number, and insurance status (In Network or Out of Network).
13. Provide the Insured's details including Name, Member ID, and Group #, and input Effective Dates and Claims Address where necessary.
14. Complete the Medical History section detailing the Area of Injury/Condition and any past surgeries or medications.
15. Rate your pain levels in the provided sections using the specified scale.
16. Sign and date the form at the end to confirm your consent for care and treatment, ensuring you understand the policies regarding insurance and cancellations.
17. Review all filled information for accuracy. Save your changes and proceed to download, print, or share the completed form as needed.

Complete your Pasadena Physical Therapy form online today for a seamless start to your treatment.