Patient Treatment Referral
PLEASE NOTE: Alabama is one of the last states in which you must have a referral/prescription for some “Physical Therapy” treatment. Evaluation of your injury can be completed without a referral, but treatment cannot start without one unless you have been seen by a MD, DO, Physician’s Assistant (PA), Nurse Practitioner (NP), Dentist, Podiatrist, or Chiropractor for the same condition within the past 90 days . A new referral for treatment can also come from an MD, DO, Physician’s Assistant (PA), Nurse Practitioner (NP), Dentist, Podiatrist, or Chiropractor licensed anywhere in the United States. Some insurances require a referral regardless.
You can bring the referral with you or have him/her fax it to 256-513-9952. If you arrive to the initial appointment without having secured a PT referral, evaluation can be completed but no treatment after the first visit can be performed. The price of the session will remain the same. Below is a referral form that you can take to your provider to have signed. Please contact us if you are having difficulty with getting a referral.
**Wellness services do not require a referral**
You can bring the referral with you or have him/her fax it to 256-513-9952. If you arrive to the initial appointment without having secured a PT referral, evaluation can be completed but no treatment after the first visit can be performed. The price of the session will remain the same. Below is a referral form that you can take to your provider to have signed. Please contact us if you are having difficulty with getting a referral.
**Wellness services do not require a referral**
| patient_referral_form.pdf |
New Patient Packets
Please download the Intake Forms along with only one survey specific to your problem. Download the PDF files, print, and fill out all forms prior to your first appointment. If you have any questions, please call our office at 256-203-3804.
| Patient Intake Forms |
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Medical Record Release Authorization
If you feel that you have medical records you would like me to review and consider while creating your plan of care, please download, print, and fill out the first page. Bring both pages with you to your evaluation. You may also email, fax, or snail mail them to me prior to your evaluation, so I can go ahead and fax them to your other medical provider.
| Medical Record Release Authorization |
Patient Privacy Notice
| privacy_policy.pdf |