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Please print and complete these forms in their entirety prior to your first appointment. Your attention to accuracy in completing these forms will allow us to bill your insurance company correctly. This will allow us to spend more focused time on your treatment during your first visit. Please bring these forms with you along with your insurance identification card (s).

Required Forms, for all clients

Additional required forms for UHC and Humana patients only.


Integrated Physical Therapy  |  Phone 608.658.5352  |  Fax 888.965.4018

313 Junction Rd, Madison, WI  |  5477 Westshire Circle, Waunakee, WI

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