​​​​UPMC Insurance


​​​​Office Location: 

3109 University Ave 

Suite C2

Morgantown WV 26505 US

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Patient Forms

On your first visit please make sure to bring:
  • Your insurance card
  • Valid form of identification
  • Prescription for Physical Therapy, if required by your insurance 
  • Comfortable loose-fitting clothing
  • Completed necessary forms below (optional)

If you prefer to save time on your first visit, call us in advance and you will be advised on which forms to fill out before you come to your first visit. Please print and fill out the necessary forms. Please print the forms for ALL patients below and an additional form for the specific body part you are coming to receive treatment for. Patients with Medicare as their primary insurance have a few additional forms to fill out. 

Forms for ALL patient:

Forms for Medicare patients ONLY:

Any Upper Body Injury:

Any Lower Body Injury/Hip:

Low back: