Physician Prescription / Referral

‚ÄčIn order to receive physical therapy through your insurance carrier, you may need a prescription or referral from your primary care physician.

For your convenience, you may download the form below, then print it out and bring it to your primary care physician to fill out. Alternatively, share the following link with your physician's office: http://bit.ly/backcoachingform. Your physician can fill out the form online, print it, and fax it to us before your appointment.

⇐ Physical Therapy Prescription/Referral Form