Walnut Creek Shadelands - 925.934.6373 | Walnut Creek Downtown - 925.378.7652 | Pleasanton - 925.426.6986

Client Information

 

New Client Paperwork

At Back On Track and Pleasanton Physical Therapy, our goal is to help make your recovery with physical therapy quick and seamless. Here you can find downloadable intake forms.
Please download, print and fill out to bring into your first appointment. Bring your insurance card and a valid form of ID. We advise arriving about 15-20 minutes prior to your appointment so we can submit your paper work and go over your insurance plan verification. 

Patient Intake Forms  (If your primary insurance is not Medicare, United Health Care, or Cigna, please fill out these forms)

Patient Intake Forms (Spanish) (Si su seguro principal no es Medicare, United Health Care o Cigna, complete estos formularios)

Medicare Intake Forms (If your primary insurance is Medicare, please fill out these forms)

United Health Care Intake Forms (If your primary insurance is United Health Care, please fill out these forms)

Cigna Intake Forms (If your primary insurance is Cigna, please fill out these forms)

Workers Compensation Intake Forms (If you are seeking treatment through Worker’s Compensation, please fill out these forms)

You will ONLY need to print out the forms that best pertain to you. If you have any questions, feel free to give any of our locations and we will be happy to help.

Insurance Information


When you schedule a physical therapy appointment (and you wish to bill your treatments through your insurance) our admin staff will work to verify your insurance benefits and inform you before beginning treatment.

 Direct Access

We accept patients without a physician referral. 

In the state of California, patients are able to be evaluated and treated by licensed physical therapists without a physician referral under the legislation. This means you no longer have to wait to get treated for injuries that would immediately benefit from physical therapy services. This allows patients to expedite treatment while saving money. Expediting treatment time helps reduce total injury time and allows you return to normal function faster. It saves you from having a costly doctor visit for a prescription prior to a physical therapy visit. For self-pay patients and some insurances, you do not need a physician referral to come to Back On Track Physical Therapy for treatment. However, certain insurances may require a physician referral in order to cover your PT visits. Call our office and our front office admin staff to verify benefits with your insurance company. We will contact your insurance provider for you to determine your benefits under direct access

 We accept most insurance plans

including but not limited to the following:

  • Aetna
  • Anthem/ Blue Cross
  • Affinity
  • Blue Shield of California
  • Cigna
  • Contra Costa Health Plan
  • TriCare
  • John Muir Physician Network
  • Worker Compensation
  • UMR
  • Medicare
  • Humana
  • Health Net
  • & more

 Insurance Terms 101

We understand that your insurance eligibility may be difficult to understand. As a courtesy, our front admin staff will verify your eligibility and benefits for physical therapy prior to your first visit. Here are some terms that represent the portion of the medical bills that you are responsible for. 

Copayment (copay)

 Your copay is the fixed amount that you pay for when you come to physical therapy. Copays are significantly less than your deductible amount and vary from patient to patient depending on your insurance plan. Back on Track and Pleasanton Physical Therapy will collect your copay prior to each visit.

Deductible

A deductible is a fixed amount that you must pay out of pocket before your insurance can cover the remaining medical expenses. Depending on the insurance plan, a deductible can range from $0 to thousands of dollars. 

 

Coinsurance

A coinsurance is the percentage amount of the medical bill that you are responsible for and the percentage that your insurance will cover. For example, somebody with a 80/20 plan is responsible for 20% of the bill and their insurance will cover the remainder of the amount which is 80%. The coinsurance is paid after meeting the deductible.

OUR HOURS

Monday: 9am-6pm
Tuesday: 10am-7pm
Wednesday: 8am-5pm
Thursday: 10am-7pm
Friday: 8am-5pm
Saturday & Sunday: Closed

11 + 14 =

Walnut Creek: Shadelands

Walnut Creek: Downtown

Pleasanton Physical Therapy