New Patient


New patients are asked to complete all required New Patient Forms (New Patient Forms) prior to their Initial Evaluation appointment.  Our billing staff will obtain information prior to scheduling regarding your health insurance plan and the benefits they provide.  You will be informed of those benefits and pre-certification requirements prior to being treated.  REMEMBER your insurance plan is a contract between you and your insurance company and you are responsible to know and understand your benefits and responsibilities.

All patients are required to complete the Patient Registration, Patient Medical Information, Designate Individuals and Notice of Information Practices forms.  Please read all of these forms carefully so you fully understand your rights, responsibilities and our financial policy. There may be additional forms required by your specific insurance plan. Our office staff will advise you of which forms you will be required to complete.

All new patients are to arrive 15 minutes in advance of your appointment time as long as your paperwork has been completed.  If you need to complete your paperwork at the time of your appointment, it is necessary you arrive a minimum of 30 minutes in advance.   All patient are also to bring their Insurance Card, Referral/Prescription & Photo ID.  Co-Pays are due at the time services are rendered.  Any payment arrangements will be discussed and confirmed prior to your initial appointment.

New Patient Forms

Patient Information
Medical Questionnaire
Information Practices
Designated Individuals
Medication/Rx List

Additional Forms

Patient Summary
Lower Extremity
Upper Extremity
Back Index
Neck Index


The Welch Physical Therapy Billing Department makes every effort to ensure we bill and collect for services rendered with the highest level of accuracy, integrity and ethics.

Welch Physical Therapy’s staff of friendly and knowledgeable billing representatives is here to assist all of our customers. Our billing representatives are employed by Welch Physical Therapy, and will consistently work our patient’s account from the first visit through the time of final payment. We ensure all billing information reaches the insurance company in a timely manner.  To that end, we are diligent about information gathering on our patient’s behalf and instantaneously communicating with insurers. We are always available during office hours to help answer questions and assist in solving any billing issues.

 Insurance Contracts

Accountable Health Plans-IHG
Aetna of Arizona
Aetna of California
Aetna Workmen’s Compensation
Affiliated Health Funds
Affordable Medical Network – AMN
AHCCCS – Mercy Care
Align Network
AMN/EVMG – Arizona Medical Network – East Valley Medical Group
Arizona Foundation for Medical Care
BCE Emergis (Admar, ProAmerica, Up & Up)
Beech Street/CAPP Care
Blue Cross/Blue Shield – PPO, HMO, Indemnity, Medicare Supplement, Workers’ Compensation
CCN/First Health Network
Champus – TriCare, TriCare Prime
Cigna PPO of California
Corvel Corporation
Evolutions Healthcare Systems, Inc
First Health/CCN
Focus Management
Fortified Provider Network-PPO & W/C
Galaxy Health Network
Global Medical Management
Great-West Healthcare of Arizona, Inc. (HMO)
Great-West Healthcare, Inc. PPO/POS
Health Net
Health Net Medicare Supplement
Health Net Open Access
Health Net Supplemental Medical
Health Net Workmen’s Compensation
HMN – Health Management Network
Humana – Choice Care (no HMO Plan)
IHP – Integrated Health Plans
Interplan Health Group – IHG
Managed Care Strategies (MCS-PPO)
Medicare – (Assignment accepted)
Metracomp (Workmen’s Compensation for United Healthcare)
NPPN – National Preferred Provider Network
NPN – National Provider Network, Inc.
Pacificare/Secure Horizons Health Systems
Phoenix Health Plan
Preferred Health Network (PHN)
Private Healthcare Systems, Inc (PHCS)
Pro America
PROCURA (Formerly QRS Managed Care)
Rockport Healthcare Group
Schaller Anderson – Banner & CHW
SCF of Arizona (State Compensation Fund)
Southwest Carpenters Trust
Superior National Insurance Co.
TLC Advantage LLC
Three Rivers Provider Network (TRPN)
Union Pacific Railroads
USA Managed Care Organization
United Healthcare
United Payors & United Providers