You must provide your auto insurance policy/claim number as we will bill your auto insurance, who in turn collects from the person's insurance who hit you. Please be aware that there is a med-pay limit on your policy. Since there is a limit, we ask for back up insurance, either your health insurance or a lien from an attorney. This way there will be no surprise bills should the med-pay exhaust. We do not bill the insurance of the person who hit you (3rd party billing) as they will not pay us.
Please let us know who your health insurance or attorney is, as a back up should your WC claim be denied for any reason.
We Evaluate Patients
Physical and Occupational Therapy
Copyright 2008-13 Derry Sports and Rehab
Sports and Rehab acknowledges that every patientís time is valuable. We have provided all of our patient forms online for you to fill out. Please fill out the Registration Form and the Medical History Form. The Cancellation Form can be printed out. Please sign it and bring it with you on your first visit. Thank you, The Staff at Sports and Rehab
Patient Registration Forms
Parental Permission Form
Consent for care and treatment provided by Sports and Rehab and The Safe Sports Network.