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Referring Physicians

Referral Form

Barkman & Smtih Physical Therapy wants to help your patients.  Here is what we need to to schedule their evaluation:

  1. Referral for PT with 3D’s
    1. Diagnosis
    2. Duration (if other than eval & treat)
    3. Date
  2. Referral signed by the referring physician and NPI included
  3. Patient’s demographics
  4. Patient’s insurance information
  5. PCP referral if required by patient’s insurance plan

Want Some Help?

Lower Back Pain

Lower Back Pain

Neck  Pain

Neck Pain

Knee Pain

Knee Pain