Click here for a printable Policy form. If printing the Policy form, please bring it with you to your first appointment or fax it to us at (802) 264-8519.
Referrals: If your insurance company requires a referral, this must be present at the start of care.
Co-pays: Due on the day of service.
Insurance: You are strongly encouranged to contact your insurance company to verify benefits and requirements for physical therapy services and if you have a deductible, co-pay, or co-insurance for which you are responsible.
Procedure: I will collect any co-pays due on the date of service, as required by your insurance company. I will then bill your insurance company for the date of service. After I receive payment from the insurance company, I will bill you if needed for any additional charges you may owe due to an outstanding deductible, co-insurance, or if the company denies the visit. I always call your insurance company on the first date of service to verify your benefits and will work with you to minimize additional charges.
Consent: I consent to be treated for the injury/illness for which I have consulted Kathleen Doehla, M.S. P.T. , within the physical therapist scope of practice.
Agreement: I agree that if my insurance company does not cover these services, because of outstanding copayments, co-insurance, or deductibles, or because of denial, that I am responsible for timely and full payments for services.
Assignment: I authorize Kathleen Doehla, M.S. P.T. on behalf of Points North Physical Therapy to bill my insurance company and receive payment directy from the company for services provided.
Where to find us
Points North Physical Therapy
435 Points North Rd.
Stowe, VT 05672
Phone: (203) 260-0215
Fax: (802) 264-8519