(646) 355-8777

Product Cart

Pelvic Floor Cash Practice Kit

Pelvic Floor Cash Practice Kit


This cash practice kit was designed for physical therapists who receive referrals from urology, gynecology and colorectal practices. This kit is a composite of forms. This kit is a composite of forms that were developed specifically for physical therapists looking to start or transition to a fee for service rather than insurance based private practice. The kit provides you with the basic tools you need to use when collecting fees at the time of service such as sample letters / computer templates for insurance companies/ patients/ referral sources that describe your financial policy.

The Following Forms are Included in this Clinic Management Toolkit

  1. Insurance Change Sample Letter
  2. New Patient Intake Form
  3. Informed Consent and Conditions
  4. Insurance Benefit Worksheet
  5. Patient Information and Financial Policy
  6. Genitourinary Referral Pad
  7. Confidential Fax Cover Sheet
  8. E-mail and Fax Confidentiality Statement
  9. Reimbursement/Billing Form
  10. Administrative Billing Form
  11. Daily Ledger
  12. Daily Notes
  13. MD Marketing Sample Letter

Note: This product is emailed in Word format so that you can instantly access these files and distribute them to patients with your own clinic's logo.