Call: (402) 325-0044
Fax: (402) 403-5078
Thank you for choosing Havelock PT for your physical herapy needs. We will strive to provide you with excellent and compassionate care throughout your time with us. Consistency is key to your recovery, so please make the most of our time together by paying attention, asking questions and engaging in the process.
New Patient Forms
Print and complete the following forms and bring to your first appointment. We appreciate you arriving a few minutes early to your scheduled appointment so we can finalize your paperwork and insurance.
- Medical History Form
- Pediatric Medical History Form | En Español
- Patient Intake Form
- Patient Financial Policy Agreement | En Español
- Consent for Treatment
- Privacy Practices Acknowledgement
- HIPAA – for review only
- Good Faith Estimate – for review only
What To Expect
Your therapist will complete a comprehensive evaluation of your condition and discuss your goals for therapy. At the conclusion of your appointment, your therapist will explain your personalized treatment plan and answer any questions you may have.
You will most likely be treated by both a therapist and therapy assistant. This team approach is part of the collaborative nature of therapy. They may give you at-home exercises you should do as assigned for your quickest and fullest recovery.
If you are receiving physical or occupational therapy services, please dress in loose-fitting clothes you can move comfortably in and wear tennis shoes.
To run an efficient practice for all patients, our schedules are strict. Please call if you are going to be late and let us know 24 hours in advance if you need to reschedule.
If you have difficulty attending the frequency of appointments your therapist recommends because of scheduling conflicts or financial concerns, please let us know so we can work toward a better treatment plan for you.
Remember To Bring
- Completed paperwork
- Valid photo I.D.
- Physician’s referral or prescription, if you have one
- Your insurance card
*NOTE: If you’re interested in a cash-pay option (not billed through insurance), please let us know.
Please contact us before your appointment if you have any questions.