Forms

Please be sure to bring the following items with you to your first appointment:

If you are unable to download and complete the necessary forms prior to your appointment, then we ask you to arrive to your appointment 15 minutes early in order to fill them out.

​​​​​Prescription or referral – For physical therapy from your physician if you were seen by a physician.

Under direct access in New York State, you no longer need a prescription from your physician to be seen by a licensed physical therapist for the first 30 days (10 visits). However, your insurance carrier may require a prescription for coverage of medical claims. Please contact your insurance company regarding your policy prior to your first appointment to verify coverage without a physician referral.

All insurance information – Necessary to process your claims.​​​​​

Co-payment – Due at the time of your treatment.  We accept check, credit card, or cash.

If you are experiencing:

Cancellations:

Your appointment time is very important to us. If you need to cancel an appointment, we request at least a 24-hour notice so that we may accommodate other patients during that reserved time slot. We do understand there are emergency situations and circumstances that are unavoidable and therefore necessitate a cancellaton. However, if you fail to keep your schedued appointment or do not call and cancel within 24 hours, we reserve the right to charge a $25.00 fee.

Sandra J. Wells PT, PC – Brochure