Patient Registration Forms
Suburban Physical Therapy is pleased to welcome you to our practice, with two offices conveniently located in Twinsburg and Brecksville, Ohio.
Once you have made your initial appointment, you can download and print the applicable forms below. Completing the forms prior to your visit will help speed up the new patient registration process.
Also, be sure to bring any diagnostic films or other test results that may have been ordered or performed by another physician.
General Downloadable Forms:
Patient Forms (Women’s Health Patients Only)
Please note: It may take a few moments to load the forms if you are using a slow internet connection. If you are unable to view the forms, you may need to download Adobe Acrobat Reader for free by clicking on the icon below.
Access to Physical Therapy - There are two ways for you to see the therapists at Suburban PT:
- Referral by a Healthcare Provider (see list below)
- Self-Referral (Direct Access)
Health Care Providers Who May Refer to Physical Therapy
- Physician (MD, DO)
- Physician Assistant (PAC)
- Nurse Practitioner (NP, ANP, PNP, FNP, GNP)
- Naturopathic Physician (ND)
- Chiropractor (DC)
- Podiatrist (DP) (For foot and ankle problems)
- Dentist (DDS, DMD) (For disorders of the jaw)
Note: Medicare patients must have a physician referral.
Direct Access - This term refers to your ability to see a Physical Therapist (PT) without a physician’s referral. As of 10/2007, 48 states allow physical therapists to evaluate patients without a prior physician's referral. Forty-four states and the District of Columbia improve access further by allowing physical therapists to evaluate and treat, under certain conditions, patients without a referral from a physician, including the state of Ohio, which passed legislation in 2003. This means that any patient has the legal right to seek out services from any PT that they wish to see.
Ohio’s direct access law has a few restrictions. After the initial evaluation, the physical therapist must inform the patient's physician of his or her findings within five days. And, if there is no substantial progress in the patient's condition after 30 days, the physical therapist must consult with or refer the patient to a doctor.
The only remaining states that presently do not have such access are: Alabama, Hawaii, Indiana, Michigan, Missouri, and Oklahoma
Forty-eight states allow PT’s to conduct an initial examination without a physician's referral (but these 6 do not allow treatment). (1)
Benefits to You:
- Save time and money by eliminating a physician referral visit - treatment is less costly and there are fewer numbers of services when compared to cases where a referral was obtained
- Eliminate delays that can result in decreased functional outcomes and frustration
- Reduce the need for long-term care by providing earlier intervention - medical studies show that immediate care for most musculoskeletal injuries can reduce healing time
- Experience the expedited recovery and return to daily tasks, work demands, and sports that early intervention provides
Our Qualifications - Our therapists are educated at least at the baccalaureate level, and receive extensive continuing education and clinical training to provide care independent of physician referrals. We also have established relationships with area physicians to make the appropriate referral, should you request or require one. Referral to a physician may be recommended if a non-PT related problem is suspected, if the condition isn’t appropriate for physical therapy, or if you don’t improve in a reasonable amount of time
Insurance - The best way to know what your insurance plan will cover if you decide to utilize direct access is to call them. In many states with direct access, insurance companies are now reimbursing because they realize that it costs less when you have the choice to access physical therapy without a delay.
Payment Options - Payment plans can be arranged for those who are concerned about the costs of their physical therapy care. Our office will work with you to establish a plan of care that will accomplish your goals and maintain efficiency of treatment.
References - (1) American Physical Therapy Association
To schedule an appointment with one of our physical therapists, please call our Brecksville office at (440) 746-1730, or call our Twinsburg office at (330) 963-2920, or submit an appointment request via our Request an Appointment form. Same-day appointments may be available, so please call the office of your choice if you wish to be seen today.