RESOURCES
Patient Info & Forms
Everything you need to know before your first visit, including accepted insurances, clinic policies, and required intake forms.
INTAKE FORMS
Patient Forms
Print, fill out, and bring these forms with you to your first appointment.
Consent to Treatment
RequiredAuthorization and disclosure of medical and therapeutic procedures, financial responsibilities, and KOOP Physical Therapy policies.
HIPAA Acknowledgement
RequiredNotice of Privacy Practices — how your health information may be used and disclosed, and your rights under HIPAA.
Initial History Form
RequiredYour medical history, current condition, pain scale, and relevant background information for your first evaluation.
Patient Rights & Responsibilities
RequiredA summary of your rights as a patient and your responsibilities when receiving care at KOOP Physical Therapy.
INSURANCE
Accepted Insurance Plans
Don't see your provider? Call us — we'll verify your coverage.
Financial Arrangements
We understand that your co-pays, deductibles, and other health care costs can be a burden. Recovering from your injury while balancing work and family obligations is a difficult process. We offer convenient payment plans that allow you to receive the medical care you need. We also accept Mastercard, Visa and check or debit cards.
POLICIES
Clinic Policies
Please review our appointment and collections policies prior to your visit.
Appointment Policy
Evaluations are scheduled at least 24 hours in advance for proper benefit verification.
All appointment cancellations require a 24 hour notification or a $25 charge will apply.
If you are 10 minutes late to an appointment, you may be asked to reschedule so that other patients' treatments are not interrupted.
If you do not show up for 3 appointments or are consistently late, the therapist will discharge you from therapy and inform the doctor of inconsistent attendance.
Collections Policy
Koop Physical Therapy expects upfront communication regarding outstanding balances. Accounts are considered delinquent if the scheduled payment is more than four days late.
If payment and/or communication has not been received after 60 days, the balance will be referred to third party collections.
A minimum of $100 is required at your first treatment. On your next session, you will be required to pay the balance of your first treatment charges.