Get Consent For Treatment And Assignment Of ... - Physical Therapy

Filling out the Consent for Treatment and Assignment of Benefits form is a crucial step in ensuring that you receive the necessary physical therapy services while also allowing for efficient processing of insurance claims. This guide will help you understand each section of the form and provide clear instructions on how to complete it accurately online.

Follow the steps to complete your consent form efficiently.

1. Click the ‘Get Form’ button to access the Consent for Treatment and Assignment of Benefits form and open it in the online editor.
2. Begin with the first section of the form where you consent to receive treatment from Blankinship Physical Therapy. Clearly indicate your acceptance of the established plan of care by checking the appropriate box or signing if required.
3. In the next section, provide the necessary authorization for the release of your health information. Ensure that you clearly understand the implications of this release and check the box that allows the sharing of your information with insurance companies and other relevant parties.
4. Proceed to the authorization of payment section. Confirm that you authorize payment to be made directly to Blankinship Physical Therapy for any insurance benefits. This may involve a verbal agreement or signing where specified.
5. Read through the office policies diligently. Acknowledge the importance of notifying the office if you cannot attend an appointment and understand the financial responsibilities laid out in this section, including late fees and other billing practices.
6. Finally, complete the signature section by providing your name and the date. This formalizes your consent and agreement to the terms outlined in the document. Make sure to review your entries for accuracy before finalizing.
7. After completing the form, you can save your changes, download the document for your records, print it, or share it as needed.

Take the next step towards your treatment by completing your consent form online.