Medical Forms

New Patient Information

Thank you for choosing Physical Therapy Solutions as your outpatient physical therapy clinic.  Our experienced staff are pleased to individualize solutions for your active life!  If you haven't made your initial appointment, please call our Dyersville clinic (563-875-8615) or our Manchester clinic (563-927-1499) to schedule your visit.

Below you will find our new patient paperwork that corresponds to your insurance carrier.  If you wish, you may print and complete them prior to your appointment.  Please bring them, along with your insurance card(s), with you to your scheduled appointment time.


We recommend planning 45-60 minutes for your appointments, however, duration is dependent upon each individual's diagnosis and plan of care.  Please wear loose-fitting comfortable clothing and comfortable shoes to your appointment. 

Direct Access Provider:
We are a direct access provider for most insurance carriers, however, some insurance companies require a physician's prescription and medical diagnosis for reimbursement.  Feel free to download our prescription form and take it to your doctor appointment as you discuss your treatment options for pain relief.  
Download one here.

Insurance Companies Preferred Provider:
Physical Therapy Solutions is contracted in-network with most major insurance companies including, but not limited to: Medicare, Medicaid, Blue Cross Blue Shield, United Healthcare, Hawk-I, and Midland's Choice.  Please call Jill at our Dyersville clinic (563-875-8615) to verify if we are a provider of your insurance carrier.