Patient Forms
Below you will find links to download Lang Hand Therapy registration forms in a convenient, editable PDF format for Medicare, commercial insurances and self-pay patients. Once complete, please send via email to staff@langhandtherapy.com or bring a copy to your evaluation. You may also print and write on the documents if preferred.
Please bring the prescription provided by your doctor to your initial evaluation; if it was sent directly from another office please call us to confirm we have received it.
If you are an established patient with us, but you’re returning for a new injury or diagnosis, we may need you to complete some or all of the new patient paperwork. Please contact us directly at 212-787-6585 if you are unsure regarding what forms must be completed or if you have any questions.
Forms for Medicare Patients
If you have Medicare, please click the following links to download forms:
MEDICARE REGISTRATION FORMS (CLICK HERE)
UPPER EXTREMITY FULL DASH QUESTIONNAIRE – MUST COMPLETE (CLICK HERE)
Forms for Commercial Insurance and Self-Pay
If you have a commercial health insurance plan, or you plan to self-pay, please click the following links to download forms:
COMMERCIAL INSURANCE AND SELF-PAY REGISTRATION FORMS (CLICK HERE)
UPPER EXTREMITY QUICK DASH QUESTIONNAIRE – MUST COMPLETE (CLICK HERE)
If we do not accept your insurance and/or you plan to self-pay, please call our office at 212-787-6585 and we can provide you with an estimate for cost of hand therapy services
