GIVEN SPORTS & PHYSICAL THERAPY

NEW PATIENT FORMS

Complete and bring to Your First Visit

WORKERS' COMPENSATION

Download these forms if we are filing claims for workers' compensation on your behalf.

FEDERAL PLANS

For those patients with Medicare, Medicare Advantage, VHA, Tricare, Dept. of Labor or other "federal" insurance.

CIGNA

Please note that most Cigna plans in Illinois require services to be billed to American Specialty Health.  The enclosed forms are needed in order to acquire an authorization for therapy.

ALL OTHER INSURANCES

Use this link if you have any insurance besides the others noted (ie BCBS, Aetna, Multiplan, PHCS, Humana, UHC) or are a self-pay patient.

NOTICE OF PRIVACY PRACTICES

We are obligated to notify you about how we safeguard your privacy.  There is no need to print this form or to bring it to your therapy appointment.