What you need for your first visit:

Patient Forms:

Please download, print, fill out (USE PEN FOR # 1-4), and bring in with you:

  1. Patient registration form (pages 1&2)
  2. HIPPA patient privacy form
  3. Financial Policy/ (Cancellation/ no show) 
  4. Covid-19 Policy

If you have any of the conditions below, download, print, USE A PENCIL (NOT a pen). fill out and bring the form that applies: (Do not worry about scoring – just answer according to how you feel over the past day or two)

        5.  Medicare Patient Questionnaire (for original Medicare as well as supplemental policies

 

Serving Central Connecticut – Conveniently located at:

BPT Wellness Center  466 East St, Plainville, CT 06062

www.BPTWellnessCenter.com

FOR PHYSICAL THERAPY APPOINTMENTS

CALL 860-589-0444FAX 860-314-1588 Open Monday – Thursday 9a.m. to 6p.m,

For your PT Product and Patient Needs www.BristolPhysicalTherapy.com