Physical Therapy Patient Forms

All the required new patient forms you will need for your first visit are available online to print, right here on our website. We want to save you time when you come to see us, so we give you the option to fill the forms out at home and bring them with you when you come for your initial clinic visit. All you need to do is download the appropriate forms to your computer, print it, fill it out, sign it, and bring it in.  Alternatively, you can come to your first visit 15 minutes early to fill out the forms.

Written Prescriptions and Authorizations for physical therapy are required for but not limited to Tufts Health HMO Plans, BCBS HMO plans, BCBS Anthem Plans, BCBS Medicare Advantage HMO plans, and GIC Unicare plans.  Please have your Primary Care Physician (PCP), not a specialist (i.e. your orthopedic surgeon), to authorize treatment for Physical Therapy (PT) through your insurance company, and fax us a copy when this is complete to: 866-949-9835. The referral department at your PCP clinic needs the first four pieces of information below in order to authorize PT treatment (otherwise, your insurance will not pay for your PT treatment) and complete the insurance authorization with your insurance.  Please be sure to follow-up with your PCP every two days until they complete it; most well-managed PCP clinics can do on the spot authorizations over the phone or day of.

  1. Clinic Name: We are Specialized Physical Therapy, SPT, located North Reading, MA.
  2. Our Group National Provider Identifier (NPI) Number:   156-871-0903.
  3. Your start date for the initial evaluation.
  4. For BCBS members, please request 26 visits from your PCP; for Tufts members, please request 9 visits from your PCP.
  5. For GIC Unicare, Cigna, BCBS Anthem, Health Plans, Aetna, and United Healthcare authorizations, SPT will make the initial request for your PT authorization if needed.
  6. *While we typically require this authorization before the patient’s initial evaluation, we will treat the patient up to two times in good faith before we must discontinue treatment due to the lack of authorization.

A Written Prescription, no more than 30 days old, for Physical Therapy is required regardless of insurance payment type (i.e. health insurance, auto accidents, or workers’ compensation). Please bring the prescription to your first visit or have your PCP fax it to our clinic: 866-949-9835. 

Tip:  What is the purpose of a Written Prescription from your doctor?  1)  It protects your financial interests in the event your insurance company decides to audit your account.  2)  It allows us to immediately start our work by treating the right injury or pain center since we know your diagnosis is 99% accurate since it is coming from a trained professional thereby not wasting your time or ours. 3)  Managed insurance companies that require physical therapy authorizations also demand a written prescription for the continuation of care.

1. Patient Intake – Required
2. Health History – Required
3. Auto Accidents
4. Consent for Minor
5. Permission to Treat
6. Notice of Privacy Practices


Thank you for choosing Specialized Physical Therapy – we can’t wait to start Moving You Forward!

Convenient Physical Therapy Clinic Location: North Reading, MA

Specialized Physical Therapy is conveniently located in North Reading, MA. We proudly serve residents in the neighboring communities including: Andover MA, Reading MA, North Andover MA, Wilmington MA, Boxford MA, Burlington MA, Woburn MA, Lynnfield MA, Melrose MA, Danvers MA, Middleton MA, Topsfield MA, Wakefield MA, and Methuen MA. We offer free and spacious parking located within a few steps away from our clinic’s door.


Schedule Your Appointment Today to Regain Freer Movement and Healthy Living!

Specialized Physical Therapy practices a comprehensive approach to total muscle, joint, and spine health. We are the preferred physical therapy clinic in Greater Boston, because we offer an extensive range of physical therapy services designed to restore your physical strength and mobility while reducing your pain. Our physical therapy clinic sets itself apart by:

  • We have helped thousands of patients with low back pain, sciatica, disc bulge, shoulder pain, shoulder impingement, frozen shoulder, hip pain, hip replacement, hip impingement, knee pain, knee replacement, ACL tears, MCL strains, LCL strains, ankle pain, and much more. Our Physical Therapy experts can help you with your range of motion, strength, balance, pain, injuries, and more. Call Now to take control of your health!
  • Providing proven techniques for alleviating minor, major, acute, and chronic pain.
  • Specializing in sports medicine, manual therapy, post-surgical care, auto accidents, workers compensation, prenatal and postpartum conditions, orthopedic injuries and overuse injuries.
  • Maintaining a clean, comfortable, private and quiet clinic, making it ideal for private consulting, educating and performing the latest physical therapy techniques.
  • Focusing on your individual needs, not the bottom line, because we are a small, physical therapist-owned and family-oriented clinic.
  • Treating one patient at a time in our private treatment room to make sure that you get the personalized care and attention you need.
  • Completing your treatment from start to finish with only exceptional doctorate trained and fully licensed Massachusetts physical therapists that have excellent skills, breadth of knowledge, and invaluable experience to help you reach your goals and succeed.


Read Our Patient Successes!