ABOUT USGETTING STARTEDFORMSINSURANCESERVICESFAQPRODUCTSDEDICATION

FORMS

Past Medical History Questionnaire
Required for everyone
Notice of Privacy Practices
Direct Access
Required if you do not have a referral to physical therapy from another medical provider.
Insurance Summary
Guide to Insurance Verification


OUTCOME TOOLS
These questionnaires are body region specific and help your physical therapist convey the “medical necessity” of your physical therapy services in communication with your insurance company.

Please fill out the form most related to your region of concern. If you have difficulty selecting a form, one will be provided at your initial evaluation.

PDF Download Neck
PDF Download Shoulder
PDF Download Hand/Elbow
PDF Download Unspecified Upper Body Concerns
PDF Download Low Back
PDF Download Hip
PDF Download Knee
PDF Download Foot and Ankle
PDF Download Unspecified Lower Extremity Concerns



Contact Us
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OUR LOCATION
Located inside the beltway at 1501 Duke Street in Alexandria, Virginia, our office is convenient to Washington, DC and surrounding areas. Click below for a map and directions.

GET DIRECTIONS

1501 Duke St. Suite 150, Alexandria, VA 22314
Phone: 703.535.5491 • Fax: 703.535.5494
Hours: 7am-8pm • info@valensphysicaltherapy.com