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.

© 2020 Maple City Physical Therapy

100 Loder Street, Hornell, NY 14843

Tel: 607-324-9344 | Fax: 607-324-9345

MapleCityPT@Gmail.com

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Learn what makes us Best of the Best.
 Call now to schedule an appointment: 607-324-9344