Cottage Grove Physical Therapy Services, Inc.



		303 Main Street • Cottage Grove, OR 97424 • Phone 541-767-2750 • Fax 541-767-2751

Physical Therapy

	What We Do

	Accessing Physical Therapy Serivces


About Cottage Grove PT

	Our Services

	Gym Information

Our Team
	Christy Karcher, *PT, OCS, Cert-MDT, CSFA* Christina has been a physical therapist in Lane County since 1986, specializing in orthopedics, sport and spine rehabilitation.
	Martha Watry, PT, Cert. MDT Martha Watry has clinical experience dating back to 1989 in the profession of Physical Therapy.
	Peter Schrey , DPT, CSCS Peter Schrey has clinical experience dating back to 2003 in the profession of physical therapy

FORMS

We look forward to meeting you as a patient in our office. Remember that most insurance companies require a written prescription from your physician so please bring that with you to your first appointment (evaluation). Click here to find out the Insurance Companies we are providers for. We encourage you to call your insurance company directly to verify your benefits.

Following are links to forms that are required at your first visit to our clinic. Please download the forms and complete them prior to your appointment. If you have any questions about the forms, feel free to call our office.

Intake Forms

TAOS

Instructions: Please complete the first section titled Functional Index. Next, complete the sections that pertain to the body part you are being referred to physical therapy for (i.e. neck pain would complete cervical/thoracic sections C, D). Also, be sure to rate the pain index level within the last 24 hours on the scale.
Privacy Practices
Our office is HIPAA compliant. Our Notice of Privacy Practices describes how medical information about you may be used and disclosed and how you can get access to this information. Please read it carefully. There is a spot on the above Patient Data form where you will need to sign that you have received, read and understand this notice.

Medical Record Request
You have the right to request a copy of your medical record. We will honor these requests as promptly as possible. We do require notification in writing by completing an Authorization to Use and Disclose Patient Information which requires your signature and then can be mailed to our office or delivered personally.

If you provide us your insurance information before your initial evaluation, we will verify your benefits with your insurance company for you. Insurance is a contract between the patient (you) and your insurance company. It is your responsibility to be aware of your benefits, eligibility, authorization requirements and co-insurance or co-payments.

Co-insurance or co-payments are expected at the time of
each visit unless other arrangements are made.