NEW PATIENT FORMS

For your convenience, please print and fill out the applicable forms and present them to the front desk when you arrive for your first office visit.


PAYMENTS & CANCELLATIONS


Payment
Cash, check and all major credit cards accepted for payment.

Cancellation Policy
If you are unable to make your appointment, kindly give our office 24 hours notice to avoid a cancellation fee.


RATES & INSURANCE

Services may be covered in full or in part by your health insurance or employee benefit plan. Please check your coverage carefully by asking the following questions about physical therapy coverage:

  1. Do I have physical therapy insurance benefits?
  2. What is my deductible and has it been met?
  3. How many sessions per year does my insurance cover?
  4. What is the coverage amount per physical therapy session?
  5. Is approval required from my primary care physician?

 
We are In-Network with the following insurance companies:​​

  • Blue Cross Blue Shield
  • Aetna
    • POS Broadplan
    • MIPPA
  • Medicare
  • Nebraska Medicaid
    • NE Total Care
    • Well Care
    • UHC Community Plan
  • Coventry
  • United Healthcare
  • Medica
  • Midlands Choice
  • Tricare West
  • UPREHS
  • ChampVA/Champus
  • VA Choice
  • Golden Rule

PAIN-FREE

PAPERWORK

&

INSURANCE

COVERAGE

Pearson Physical Therapy, P.C.
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If you would like our team to coordinate care with another physician, please complete a release of your medical records (HIPPA):