Patient Information

Parking

Easy street parking is available on Foster, Wolcott and Ravenswood. Watch signs restricting parking during rush hour.

New Patient Paperwork

New patients please refer to the New Patient Paperwork tab below to complete and print out the forms online and bring the completed paperwork to your initial evaluation. If you are unable to complete forms online, please come 30 minutes prior to your scheduled appointment to complete the required forms.

Identification

Please bring a state ID or valid driver’s license, insurance card and doctor’s referral/prescription (if available). If you are under the age of 17, you are considered a minor so please bring a parent or guardian to your initial evaluation. If you are a wellness patient, please still bring your state ID or valid driver’s license.

Clothing

Please bring/wear clothing that you can comfortably exercise in. Please ensure that you wear clothing that exposes the body part that you are seeking treatment i.e. shorts for a knee or ankle and tank top for a shoulder injury.

 

Payment Information

Insurance Patients

We accept most major insurance plans and federal programs. Please contact our office for a complimentary benefits verification. It is important to us that you understand your insurance coverage so that we can tailor a plan that fits your budget.

Phone: 773-516-4146

Email: billing@exemplarphysicaltherapychicago.com

Self Pay

We also offer comprehensive self-pay programs for those patients whose insurance coverage is cost prohibitive and for those who are seeking health maintenance services geared towards preserving their optimal function, fitness and active lifestyles. For additional information please contact our office.

Insurance Forms

 Self Pay Forms

 Health and Privacy Forms

Telehealth Consent

GET OUR SPECIAL COVID 19 PROTOCOL HERE