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8305 Falls of Neuse Rd, Suite 102 Raleigh, NC 27615 Phone # 919-870-4444 Fax # 919-870-4447

Patient Responsibilities

 We provide the best physical therapy in the triangle region.  We are only able to do this if our patients agree to and comply with the below patient responsibilities:                                                                                                                                                                               

1)       You agree to show up on time, dressed for the right environment (gym/pool) and at the right hour.

When you are late, show for the wrong environment or come at the wrong hour, we are forced to handle a patient load that we did not anticipate.  This hurts not only your care, but other patientsí care as well.  First of all, you donít receive the direct care we anticipated giving you.  Secondly, the other patients who are here when you show up do not get the direct care that they were scheduled for.  Lastly, we stress trying to give everyone the same excellent service despite the difficult circumstances.

2)       You agree to comply with your treatment plan as prescribed by your physical therapist, including

a.       Showing up for all of your visits each week

b.       Showing up ready for the right environment.

c.        Performing your home exercises as prescribed to you.

d.       Performing &/or adjusting any other daily or nightly activities that you are asked to alter. 

We have had amazing success with our patients due to the fact that they comply with their treatment plan, show for their visits and come ready for the right environment.  If you have any concerns, time or financial restrictions, please bring them to our attention, so that we can figure out how to handle the situation.  We will work with you to help you integrate physical therapy into your lifeís schedule, so that we can resolve your issue.

The front office is only responsible for collecting moneys due to the clinic and scheduling the patients as instructed to do so by the caregivers on your checkout sheet.   They cannot change treatment plans, including the number of visits per week that you attend, the number of weeks planned for your treatment or even the environments that you are to be treated in for each visit.  All such questions must be directed to your caregivers.  If you are forced to cancel one of your prescribed visits and you are not able to set a makeup for a different day of that week, it is your responsibility to relay this to your CAREGIVER as well as the front office.  

By signing below, you are stating that all your questions have been answered, so that you completely understand what is expected of you during your treatment at our facility.  By signing below you are also declaring that you understand that your physical therapist may conclude your treatment at our facility at any point in time if you do not comply with all the responsibilities enveloped within this agreement. \ 

Patient Initials:       Date:     Patient Signature after printing:_________________________________________

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