New Client Information

Patient Information Form
General patient and insurance information

Patient Health Intake Form
Personal health information

Health Insurance Information & Authorization
Health insurance information

Notice of Privacy Practices - Click here to read our policy
HIPAA requires all patients to read our HIPAA privacy policy and sign this form. The original signature page will be kept in the patient's record.

Medicare Information & Authorization
All Medicare patients must read and sign.

Cancellation Policy 

 

All patients must read and sign this form.

We accept the follow insurance providers:

Medicare
Medicare Advantage Plans
United Healthcare
Optimum Choice
Mamsi
One Net PPO
Informed/UHC
Compass Rose
M.D.I.P.A.
Cigna PPO/Greatwest
Anthem PPO and Federal
Healthkeepers and Healthkeepers Plus
Beechstreet
AETNA HMO and PPO
Carefirst HMO PPO Federal
Tricare Standard/Extra/Prime
PHCS/Multiplan
Community Health
Integrated Health
VA Health Network
Kaiser Permanente
Worker's Compensation
Corvel
Medrisk
Dept of Labor
Focus
VML
Network Synergy
Align Networks

If you would like more information on your insurance coverage for physical therapy, please call any of our clinics and our staff would be happy to assist you.

 

 

   
         
  Centreville: (703) 818-8804  |  Gainesville: (703) 753-7600  |  Fairfax: (703) 385-2855  |  info@resultsrehab.net  
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