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GIVEN SPORTS & PHYSICAL THERAPY

NEW PATIENT FORMS

Complete and bring to Your First Visit

Given Sports & Physical Therapy
HEALTH INSURANCE & SELF-PAY

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.

Given Sports & Physical Therapy
FEDERAL PLANS

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

Given Sports & Physical Therapy
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.

Given Sports & Physical Therapy
WORKERS' COMPENSATION

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

Given Sports & Physical Therapy
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.