Your Personal Best PT

Forms

You hate paperwork…and so do we. But we try to make it easy as possible for you.

IF YOU HAVE A BCBS HMO PLAN

YOUR PCP WILL HAVE TO FILE A REFERRAL WITH BCBS IN ORDER FOR YOUR COVERAGE TO BE VALID.

Please print and fill out the forms prior to your first appointment.  If you have problems with the files or any questions about the forms, please call us at 512-852-8434. We’re glad to help!

We just want to know a little more about you, so we can get to the core of your issue, and start helping you faster.

ALL NEW PHYSICAL THERAPY PATIENTS

Also fill out additional forms for pertinent body part

  1. NEW PATIENT QUESTIONNAIRE
  2. YPB_NEWPATIENTFORMS 2012.pdf

WOMEN’S HEALTH PATIENTS

  1. VULVAR VAGINAL PAIN FORMS
  2. PELVIC FLOOR STRENGTHENING FORM
  3. TRUNK PELVIS OB FORMS
  4. PELVIC FLOOR CONSENT TO TREAT

MEN’S PELVIC HEALTH PATIENTS

  1. BOWEL DYSFUNCTION EVALUATION FORM
  2. MALE PELVIC FLOOR EVALUATION FORM

CHOOSE RELATED FORM FOR PERTINENT BODY PART

ADDITIONAL FORMS REQUIRED FOR INSURANCE PURPOSES

MEDICARE PATIENTS

UNITED PATIENTS

Only fill out if you have United Healthcare insurance

INSURANCE AND DISCOUNTS

We extend a 10% discount if you are paying Cash Out of Pocket, have high deductible insurance plans or if you are opting out of your HMO (please see Cash Discounts below). We are an in-network provider with the insurances listed below. We also accept Workers Compensation and Letters of Protection for automobile accidents. Please see the “Billing FAQ’s” to see if your insurance requires a referral.

If you do not see your insurance company listed, please contact your carrier or
Your Personal Best. There is a good chance that your insurance will cover your office visit with Out-of-Network Benefits.

We also offer programs for cash paying clients. CLICK HERE for more information.

We encourage all of our patients to be aware of their health benefits. If you have questions regarding your insurance plan before you begin therapy, please call us at (512) 852-8434. Join our mailing list for special offers and coupons, SIGN UP here.