Providing quality health care takes time, but it should not take away time that you could better spend doing other things. That's why we're providing the forms that you need to complete before your appointment with the Sentara Rehabilitation Network. So, instead of arriving 20 minutes before your appointment to complete paperwork, you can do the paperwork at your convenience ahead of time.
Forms #1, 2 and 3 are for everyone to complete. Form #4 only applies if you have Medicare. If you have any questions about this process, just call (757) 668-4114. Please take a moment to read the Sentara Healthcare Integrated Notice of Privacy Practices, as this is required information for those receiving treatment at Sentara.
Simply click on the form name to download and print. (Requires Adobe Acrobat Reader - click on the graphic to download a free copy!)
| Form |
Instructions |
#1
Registration
(download PDF File)
|
This form provides us with your demographic information and assists us in submitting your claim to your insurance carrier. |
#2
Patient History
(download PDF File)
|
This form provides a brief clinical history and will help the therapist customize your treatment plan for maximum benefit. |
#3
Consent for Treatment and Financial Agreement
(download PDF File)
|
This form allows us to complete your initial evaluation and file your insurance claims. |
#4
Medicare as Second Payor
(download PDF File)
|
This form only needs to be completed if you have Medicare and another supplemental insurance plan. |
#5
Patient Orientation and Cancellation Information |
This form explains appointment and cancellation policies. |
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