ISLAND THERAPY CENTER Sanibel
Physical Therapy, Massage, Pilates, Fitness 239-395-5858
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Patient / Physician Forms

 

New Physical Therapy Patients:

  • Once you have scheduled an appointment, we can e-mail the appropriate intake forms directly to you to complete at home before your appointment.  You may be asked to complete a questionnaire which will give your therapist additional insight into how your condition affects your daily activities, work or recreational activities.
  • If you would rather complete the forms in our office, please arrive 15 minutes prior to your appointment.
  • The Notice of Privacy Practices contains more detailed information about our Patient Privacy and HIPAA Policies.  HIPAA is an acronym for the "Health Insurance Portability and Accountability Act" enacted by the U.S. Congress in 1996, which addresses the use and disclosure of an individual's health information. Please print or save a copy for your records.
  • For your first visit, please dress in loose, comfortable clothing, and bring your insurance cards, driver's license, completed forms and a list of your current medications.  If you have access to X-Ray, MRI or similar reports related to your diagnosis, please bring them with you for your therapist to review.

 

Prospective Patients and Physicians:

  • Please print the Referral Form to bring to your physician.  The physician's office can simply fax the form directly to our office (239) 395-5857.  This form also contains a list of services we provide.
  • In Florida, we can provide physical therapy for up to three weeks without a referral, however most insurances require a referral for reimbursement.
  • If your therapist identifies issues that require a physician's attention, or if you will require greater than 3 weeks of therapy, we can assist you in scheduling a physician appointment.