Patient Resources & Forms
For New Patients
You will find all new patient forms located in the section below.
Helpful Patient FAQs
Please visit our FAQ section located below for getting started help, initial visit information, insurance resources, and patient surveys.
New Patient Forms
New Patient Forms *fill out prior to appointment
You can print these out and bring them to your first appointment. Or you can email them to info@proformancerehab.com prior to your visit.
Patient Registration Form
Privacy Document
Medical History Questionnaire
Social Media Release Form (Optional)
Initial Visit Treatment Surveys: Depending on your condition, we also ask you to also complete whichever form(s) are applicable to your condition for treatment:
Neck- *Neck Disability Index
Shoulder- *QuickDASH Form
Back- *Oswestry Low Back Pain Disability Index
Lower Extremity- *Lower Extremity Functional Scale
Knee- *Knee Injury and Osteoarthritis Outcome Measure
Foot- *Foot and Ankle Ability Measure
Patient FAQs & Insurance Resources
Getting Started With Physical Therapy
Washington State allows individuals to refer themselves to physical therapy, however many health insurance plans will only cover physical therapy services when the process includes a referral or prescription for physical therapy from an approved health care practitioner. These practitioners include medical doctors, chiropractors, physicians assistants, nurse practitioners, naturopathic physicians, and podiatrists. We accept most major insurance companies. If you have health insurance, you may contact your provider to determine the requirements of your plan and whether or not you need a prescription to have the services covered.
If your insurance requires a prescription, contact us once you have obtained one from your health care practitioner by calling us at 206-322-2842.
If you do not need a prescription, or do not have insurance and would like to self-refer in a self-payment situation, please call us at 206-322-2842. Please ask about our self-payment arrangements.
What To Expect For Your First Office Visit
We ask that you arrive 10-15 minutes before your scheduled appointment time so that you may fill out the necessary paperwork and for our front office to take your information. To expedite this you can fill these out beforehand by downloading them from our website on the Resources page. You can either email the completed forms or submit them when you check-in.
Please Bring:
- new patient forms if you haven’t emailed them
- ID/License
- Insurance card
- Loose-fitting clothing, shorts, t-shirt, or tank top corresponding with the body part being evaluated. We do have shorts/t-shirts on hand.
Insurances We Accept
Please check your coverage carefully by asking the following questions:
- Do I have physical therapy insurance benefits?
- How many appointments does my health insurance cover each year?
- What is my deductible and has it been met?
- Do I need a referral or prescription from my primary care provider?
ProFormance Rehab is happy to bill your insurance for you. We are In-Network with the following carriers:
- AETNA
- CIGNA
- FIRST CHOICE HEALTH NETWORK
- GEHA
- HMA
- KAISER ACCESS PPO ONLY
- LIFEWISE
- PREMERA-BCBS
- PREMERA-MEDADVANTAGE PPO ONLY
- REGENCE-BS
- REGENCE FEDERAL PLAN
- REGENCE GROUP ADMINISTRATORS
- REGENCE-MEDADVANTAGE PPO ONLY
- UNIFORM MEDICAL PLAN
- UMR
- WA STATE LABOR & INDUSTRIES & SELF INSURED PLANS
We also offer Self Pay rates.
If you don’t see your plan listed, please contact your carrier to check your Out-of-Network Benefits. We will be happy to bill them as a courtesy for you.
Please contact us with any questions.
Billing Policy Form
View & Download:
Billing Policy PDF
Follow-up Forms By Condition
Neck Disability
Follow-Up & Discharge Survey
View & Download
Neck Disability Follow-up PDF
Oswestry Low Back Disability
Follow-Up & Discharge Survey
View & Download
Oswestry Disability Follow-up PDF
Lower Extremities
Follow-Up & Discharge Survey
View & Download
Lower Extremity Follow-up PDF
Upper Extremities
Follow-Up & Discharge Survey
View & Download
Upper Extremities PDF
Contact
Phone: (206) 322-2842
Fax: (206) 322-6232
Email: info@proformancerehab.com
Seattle,WA
2815 Eastlake Ave E, Ste 170
Seattle, WA 98102