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Sands Point Physical Therapy
ROCKAWAY PARK
2-30 Beach 102 Street Suite 3A
Rockaway Park, NY 11694
T: 718- 945-9575
F: 718-945-5671
rockaway@sandspointpt.com
Experienced, Professional, Compassionate
Patient Forms
Consent Forms & Financial Policy/Cancellation Form:
Patient Consent Form
Financial Policy Form
If you have Medicare as your primary insurance fill all these forms out:
Medicare
Pain Scale
Medication Form
OPTIMAL Form
Medicare and all other insurances, print, fill out this paperwork:
All Patients Fill This Out 1
All Patients Fill This Out 2
New Employee Paperwork
If you are a new employee, print and fill out all of the following paperwork. Also bring with you a photocopy of either the photo page of your US Passport or a photocopy of your Drivers License and Social Security Card.
Employee Application
Non Compete Agreement
Federal I-9 Form
LiteCure Laser Consent Form
If you are interested in Laser Therapy, print, read carefully and sign this paperwork:
Laser Consent Form
Insurance
ACCEPTED IN NETWORK
Medicare - Medicaid - BCBS - Cigna - UHC - 1199
No Fault - Workers' Comp(Except MagnaComp) - All Local Union Plans
ACCEPTED OUT OF NETWORK
Aetna - Empire Plan(MPN) - GHI(Emblem Health) - MagnaCare - Oxford
WE DO NOT TAKE
ElderPlan - EverCare - FIDELIS - HealthPlus - HealthFirst - MetroPlus - HIP/HCP
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