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25% off a 3-month fitness membership
(New Members Only)
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607-324-9344

Paperwork

In order to be prepared for your visit, print and complete these forms and bring them to your initial examination visit. 

Your insurance may require additional paperwork, we will advise you of this at your arrival!

Maple City Physical Therapy

Patient Health Questionaire

Health Information Authorization Form

Patient Payment Policy

Maple City Health and Fitness

Fitness Center Intake Form

 We at Maple City PT know that healthcare can be expensive. We offer a reduced cash rate for patients with no insurance or insurance plans that are out of network. We can also work with patients to minimize costs by helping patients establish an independent home exercise program or transition to Maple City Health and Fitness. We are happy to discuss options with anyone concerned about the cost of their treatment. Call us at 324-9344 for more information.