For Patients

Forms

The following forms are available for your convenience.  If you would like, these can be printed out and completed before your first appointment.

Patient Registration
Patient Registration word.doc
Microsoft Word document [30.0 KB]
Informed Consent Form
Informed Consent Doc.doc
Microsoft Word document [25.0 KB]
Acknowledgement of Notice of Privacy
Acknowledgement of Notice of Privacy Pra[...]
Microsoft Word document [26.0 KB]
PATIENT QUESTIONNAIRE.doc
Microsoft Word document [53.0 KB]

Billing Policy

  • Terry Frye MS PT is a preferred provider for most insurance companies.  It is the patient's responsibility to check with your insurance company on your physical therapy benefits and your deductible.
  • Preferred Provider for Premara, Anthem, FEP, Asuris, Aetna, First Choice, Cigna and Options GH. She will bill out of network for United Health Care.
  • The patient is responsible for all co-pays, co-insurance and deductibles to Terry Frye Physical Therapy.
  • TFPT accepts cash and checks.  Sorry no credit cards
  • Please make checks payable to Terry Frye Physical Therapy or TFC.
  • Payment is due at time of service.
  • A $25 charge will be applied to your account for broken appointments unless 24 hours notice is given.  Please note that patient's insurance company will not cover this charge.
  • Two consecutive missed or 'no-show' appointments without cause will result in future patient appointments being removed from the schedule.