Patient Forms

It’s always a good idea to make sure your health insurance plan has coverage for physical therapy evaluation and services before you make your first appointment. Below are the most common network insurance companies we work with. If you don’t see yours on the list, please check with our billing office at (308) 872-5111 to see if we can accommodate your plan.

In addition, you may download and print our new patient forms below and bring the completed forms with you to your first appointment to expedite the check-in process. Note that even if you have been a patient at TEAM Physical Therapy in the past, each new injury or rehabilitation plan will require new paperwork.

Network Insurance Companies

Don’t see your insurance provider on the list? Call our TEAM Physical Therapy billing office at (308) 872-5111 with your insurance information. We handle many other plans not on the list!

Patient Forms

New Patient Paperwork (408 KB)
Payment Terms & Conditions (668 KB)
Automatic Payment Authorization (297.74 KB)
Notice of Privacy Practices (99.66 KB)
Workers’ Compensation/Liability (783.04 KB)
Patient Bill of Rights (649.5 KB)
Patient Health Questionnaire PHQ-9 (442 KB)
WellRX Questionnaire (84 KB)

Instructions: These forms are fillable pdf forms. To utilize this feature, click the form above, then download and save it to your computer. Open the file you saved to your computer, and type in the required fields and save. If your form has a signature line, a hand signature is required. We suggest you print out the form, hand sign, and bring with you to your first visit. You may also scan it in and email your completed/signed forms to office@myteampt.com.

Is this your first visit to TEAM Physical Therapy? Read what to expect on your first visit.