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Email: info@QualityCarePT.com Phone: (425) 486-6079
Patient Forms

We've gathered our patient registration, medical history forms and insurance information into one convenient location. Please complete the following:

Print and fill out the following forms:

Patient Registration Form

Medical History Form

Google Map

Select one of the following forms that best fits your condition:

Neck and Upper Back

Lower Back

Upper Extremity  (Hand, Wrist, Elbow, Shoulder)

Lower Extremity   (Hip, Knee, Ankle and Foot)

Hand

TMJ

Neuromuscular  (Balance and Coordination)

For multiple areas, please choose the area your most having issues with. If you are unsure of which form to fill out, please call our office at 425-486-6079.

Insurance Information: We want you to be informed and confident with your insurance coverage and fiscal responsibility. By clicking on your insurance company you will be directed to their home page where you can login and gain access to your coverage and benefits. You may be responsible for a co-pay or deductible. If you have any questions or do not see your insurance company please call our office at 425-486-6079 and we will be happy to assist you.

Aetna HealthNet Personal Injury Policy (PIP)
Beech Street KPS Health Plans - First Choice Premera
Blue Cross / Blue Shield Labor and Industries (WA State) Private Healthcare Systems
Blue Cross Blue Shield Federal Labor and Industries (Federal) Regence
Carpenters Trust Lifewise Regence Med Advantage
Cigna (PPO and POS Plans Only) Megalife Uniform Medical
First Choice Pacificare United Health Care
Great West Healthcare    

Questions to ask Your Insurance Company

1. If you have a deductible does it apply to out -patient physical therapy? If it does apply how much has been met?
2. If you have a co-pay, does it apply to out-patient physical therapy?
3. What is the dollar/visit limit for physical therapy?
4. What % does insurance pay of the allowed amount for physical therapy?
5. Do you need a referral/script from your primary care provider to see a Physical Therapist?
* We bill as out-patient office physical therapy.

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APTA Brochures


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