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  • As of September 1, 2019, patients can go directly to a physical therapist without a physician prescription. Whether you need help to maximize athletic performance, have a chronic injury or a recent onset of pain, our clinic can help you reach your goals.

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  • Physical Therapy Treatment without Referral Disclosure

  • Please Read Carefully and acknowledge below: 

  • I understand that physical therapy treatment without a referral will be based on the physical therapist’s examination and evaluation of my current condition which may result in identification of movement and mobility dysfunction.

    I understand that the physical therapist will not diagnose an illness or disease, and that physical therapy is not a substitute for a medical diagnosis.

    I understand that if a medical diagnosis has already been established by a qualified
    healthcare practitioner, the physical therapist will take it into consideration during the evaluation process.

    I understand that the physical therapy plan of care developed by the physical therapist may not be based on radiological imaging.

    I understand that if images have previously been obtained, the physical therapist may use the information as part of the evaluation process.

    I understand that if the physical therapist identifies a need for radiological imaging, the physical therapist may recommend that radiological imaging be obtained.

    I understand that my health insurance may not cover physical therapy services if provided without a referral from a qualified healthcare practitioner.

  • I acknowledge that I have received the above disclosure.

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