Patient Forms and Info.
Please call the clinic closest to you. We guarantee that we will offer an initial evaluation appointment within 24 hours. Once you have made your initial appointment, please fill out the following forms and bring them with you along with your insurance information. This will help you get to a therapist on time and worry-free.
Download:Authorization for The Release of PHI Financial Assistance Form Medicare Advanced Beneficiary Notice ABN 10 2021 Non-Medicare Notice of Non-Coverage Form 2021 Bill of Rights Consent for Treatment and Financial Policy 06 2022 Medicare Secondary Payer Questionnaire 10 2021 New Patient Registration Packet 01 2023 Notice of Protected Health Information Practices 10 2021 Medicare New Patient Registration Packet 01 2023 CACC Patient Medical Healthcare Questionnaire
Insurances We Accept
Colorado is a direct access state. This means you may see a physical therapist without a medical referral. However, for insurance reimbursement, you may need a physician referral.
Reimbursement for our services may be handled on a self-pay basis or through insurance.
Below are the insurance companies with which we are contracted. Please check with your insurance company to confirm we are a participating provider with them.
NOW ACCEPTING MEDICAID
|Insurance Provider||Insurance Provider||Insurance Provider|
|AARP Medicare Complete (by Secure Horizons)||Affordable Network|
|First Health Network (Include workers’ compensation)||Great West/One Health||HIS Health Plans- EPO, HMO|
|Humana (PPO)||Intercare/CNIC||Kaiser Permanente (PHCS plan only)|
|Medicare||Mutual of Omaha||Optum Network Providers|
|Pacificare PPO, HMO, POS||Private HealthCare Systems (PHCS)||Pinnacol|
|Railroad Medicare||Rocky Mountain Health Plans||Rocky Mountain UFCW|
|Secure Horizons||Sloans Lake Managed Care (Cofinity)||Travelers (Workers’ Compensation Only)|
|Tricare for Life-Standard||Tricare Prime||United HealthCare|
|Universal SmartComp||US Department of Labor (OWCP)||Workers’ Compensation|