Intake Form

» Intake Form

FYZICAL Therapy & Balance Centers, Sanibel is an approved Medicare provider. Our goal is to keep our fees reasonable and well in line with comparable providers in the area.

Our office makes sure that billing and insurance-related issues are handled in a quick and efficient manner as much as possible. After verifying your coverage with your provider, we’ll inform you of any co-payment charges. We take care of most of the paperwork so you don’t have to.

Have you had Physical Therapy this year?
If yes, do you know what amount Medicare has allowed so far for Physical Therapy?

Have you had Speech Therapy this year?
If yes, do you know what amount Medicare has allowed so far for Speech Therapy?

* Our office will monitor your physical therapy benefit and let you and your therapist know when you are approaching your maximum allowance.

Medicare will not pay for outpatient physical therapy if you are receiving home health visits for ANY reason. For example if you have a nurse coming in only to check your blood pressure or to give you an injection, you may not be seen for physical therapy at our clinic and have Medicare pay for it. Please be sure that you have been officially discharged by your home health agency before starting out-patient physical therapy. You will be asked if you have had home health and for your agency name and phone number.

For our visitors to the island who are not covered under Medicare, we will be happy to inquire about coverage from your insurance company. Please be aware that your insurance coverage is a contract between you and your insurance company and ultimately you are responsible for your bill. We do expect co-pays at the time of service and for your convenience do accept Visa, and MasterCard. We also have Self-Pay Rates for our visitors from out of the United States, or those whose insurance companies do not have out-of-network benefits. Please call for the current rates.

Download Patient Forms

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New Patient Intake Forms

We are temporarily closed. Patients, please reach out to us to let us know how you are doing.