​Middlesex Rehabilitation
Associates, Inc.

Orthopedic Physical Therapy

​Patient Information Center

​First Visit:    Plan for your evaluation to take up to one hour
​                                  Arrive 15 minutes early to complete appropriate paperwork
                                  You will complete Patient Information Forms
​                                  You will complete Body Area Specific Information Form(s)

                                  You will sign Authorization to Treat
​                                             Patients under 18 must have a parent or guardian present, to sign
                                   You will sign Assignment of Insurance Benefits to bill, appropriate insurance, for services
​                                   You will sign Acknowledgement of HIPPA  Patient Privacy Information

​What to Bring:  Insurance Card(s)
​                                             Insurance Information, if injury related to Automobile or Work Injury
                                             Physician Referral/Prescription, if any
​                                             Complete list of medical problems and current medications
                                             Wear appropriate clothing to possibly access the injuried body part
​                                             Appropriate Patient Co-Payment Amount
                                                         We accept cash, check or credit cards
​                                            Your calendar to schedule future appointments