802.849.9308

1282 Main Street,
Fairfax, VT 05454

FAIRFAX FAMILY PHYSICAL THERAPY, P.C.

NEW PATIENT INFORMATION

1.  WHAT TO EXPECT AT YOUR FIRST VISIT

Welcoming Committee:
Please let us know if you are allergic to or are just not fond of dogs or cats so that we can put them upstairs prior to your arrival.  We have a cat (Prince Charming) who lives at the office and loves to greet you in the parking lot and a dog (Johnny Cash) that enjoys all the affection you have to offer. 

Paper work:
We will need you fill out an Intake form, History form, and sign both a consent and cancellation policy form.  (See links below)  You may either come to your appointment 10-15 minutes early to complete this in our waiting room or you may print these off our website, fill them out at your own convenience, and bring them with you to your appointment. 

Insurance:
In the state of Vermont, as a patient, you have direct access to a physical therapist, meaning removal of the physician referral mandated by state law to access a physical therapists’ services for evaluation and treatment.  Physical therapists are educated and receive extensive education and clinical training in the examination, evaluation, diagnosis, prognosis, and intervention of patient/clients with functional limitations, impairments and disabilities.  Physical therapists receive the training needed to recognize when a patient presents with signs and symptoms inconsistent or outside their expertise and require a referral to a physician or other specialist.

In spite of this, some insurance companies still require a referral from your physician and/or preauthorization prior to care.  Please see our insurance tab for more insurance information.   

It is your responsibility to know and understand your insurance company’s coverage for physical therapy; including what you may owe for a deductible, co-pay, co-insurance and coverage for Durable Medical Equipment such as braces and orthotics. 

Please bring your insurance card or your claim number if it is a workers compensation or automobile insurance claim. 

Please check with your insurance company regarding whether you are responsible for a co-pay, co-insurance, or deductible and be prepared to make the appropriate payment.

We accept most insurances.  It is your responsibility to call your insurance company to check but you may also call Faith Dion at
802-849-9308 for help with this.

Please visit our insurance section for more in depth detail regarding insurance and physical therapy.


2.  WHAT SHOULD I BRING TO MY FIRST APPOINTMENT?

What to wear:
Please wear or bring with you to change into: tank top or sports bra, shorts, and sneakers.  Also, depending on the evaluation you may be required to change into a Johnny top (gown). 


3.  FORMS - Click any link below to open form in PDF format, Print form, fill out and bring in to office.

Cancellation And No Show Policy Agreement
Consent & Release Form
Data Collection, Initial Intake Form
Data Collection, Patient History


4.  PAYMENT OPTIONS

We accept cash or checks only.  If you have an HSA (Health savings account) with a debit card you may ask them for checks to make your payments with. 


5.  CANCELLATION POLICY

Click the Cancellation And No Show Policy link in the Forms Section above to read, print, and sign the acknowledgement form.

 


Prince Charming

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