Reynolds and Associates Physical Therapy
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Reynolds and Associates Physical Therapy Forms

Referral Form
Our forms are available here so you may save time by printing then filling them out prior to your appointment. At your first appointment, please bring these completed forms, your insurance cards, referral (if given), and photo ID. Or you may email your forms to us at [email protected] or fax them to us at (919) 933-1150. Thank you.

New Patient Registration
Patient Health History
Health, Pain & Activity Inventory


Reynolds & Associates Physical Therapy�s services are covered by most insurance companies. Because of the nature of insurance coverage, we verify insurance coverage prior to office visits. We handle all processing of primary insurance claims in house. Should you have any billing questions, we have personnel here to help answer your questions.

Patients with Medicare or any Medicare replacement plan must have a physician that will sign off on their plan of care if they do not have a referral. Most other insurance plans do not require a referral.

We are a network provider for the following plans:

  • MEDICARE and most Medicare Replacement Plans
  • BLUE CROSS BLUE SHIELD - Federal and State Health plan members. Blue Advantage, Blue Optios and Blue Select. Unfortunately, BCBS did not allow us to be in network with Blue Value or Blue Local.
  • UNITED HEALTH CARE - Includes Optum HealthCare, UMR, Oxford Health Plan
If your insurance carrier is not listed above, please call as we continuously strive to become an in network provider with more plans. Also we will be happy to verify your benefits and determine the cost per visit when out of network. We also have a self pay option available. Please do not hesitate to contact us for further inquiry at (919) 933-1110.

If you�ve been in an automobile accident, please inform us so we can confirm that we can or cannot accept assignment from the third party payer. Otherwise we will submit your medical claims through your health insurance company or accept out of pocket payments and it will be your responsibility to seek reimbursements from your auto insurance carrier or any legal proceedings you may have pending.

If you do not have health insurance but are in need of a consultation/treatment, we encourage you to contact us to discuss self pay payment options.
Reynolds & Associates Physical Therapy · 11312 US 15-501 North, Suite 401, Chapel Hill, NC 27517 · 919.933.1110 · [email protected]
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