1. Fill out the patient paperwork that matches your situation:

For NON-PEDIATRIC PATIENTS:

USING INSURANCE:

Blue Cross, United Healthcare, Cigna, Aetna, Humana, Medicare Advantage Plans

• • Intake Packet Teletherapy for NEW Patients with policies listed above
  • Teletherapy Services Waiver for ALL current patients with policies listed above

Medicare (Medicare is NOW COVERING teletherapy 4/29/2020)

• • Intake Packet Teletherapy for NEW Patients with Medicare
  • Teletherapy Consent Only for ALL current patients with Medicare

SELF-PAY:

• • Intake Packet Teletherapy for NEW Patients not using insurance
  • Teletherapy Services Waiver for ALL current patients not using insurance

CHAPEL HILL SCOLIOSIS AND POSTURAL RESTORATION CENTER (CHSPRC):

• • Intake Packet Teletherapy for NEW Patients to CHSPRC
  • Teletherapy Services Waiver for ALL current patients of CHSPRC

For PEDIATRIC PATIENTS:

USING INSURANCE:

Blue Cross, United Healthcare, Cigna, Aetna, Humana

• • Intake Packet Teletherapy for NEW pediatric patients
  • Teletherapy Services Waiver for ALL current pediatric patients

Medicaid

• • Medicaid Pediatric Intake for NEW pediatric patients
  • Teletherapy Consent Only for ALL current pediatric patients

SELF-PAY:

• • Intake Packet Teletherapy for NEW pediatric patients
  • Teletherapy Services Waiver for ALL current pediatric patients

2. Then please tell us a little more about your problem by completing one or more of the questionnaires related to what you would like us to help you with.

Back Pain

Scoliosis

Neck Pain

Foot & Ankle Pain

Other Leg Pain

Hip Pain

Shoulder Pain

Hand or Elbow Pain

Balance or Dizziness Problems

For patients with scoliosis, please forward x ray images prior to visit if possible and bring to initial visit. We recommend at least a standing side view and back view of the spine including the base of the head down to the level of the hips. Please review: Xray The Smart Way.