Downloadable Forms

Please print and fill out all "Initial Examination Intake" forms and choose the appropriate "Injury Specific" form to bring with you on the day of your initial evaluation.


Initial Examination Intake





Injury Specific Forms









Accepted Insurances


We are In Network with the following insurance carriers:


AARP

Aetna

Anthem Blue Cross Blue Shield

Auxiant

​Cigna

Dean (PPO Only)

Group Health Cooperative

Humana

Medicare

Physician's Mutual

Physician's Plus (PPO Only)

Tricare and Health Net Federal Services

United Health Care

United Medical Resources (UMR)

VA-Madison, VA Milwaukee

Worker's Compensation - Align, Homelink

WEA

WPS

​​

*If your insurance is not listed, please call us. The list is always changing.



New Patients


"How Do I See a Physical Therapist?"


In Wisconsin you may see a Physical Therapist without a doctor's referral.

If a referral is needed in order for insurance to cover services, we will work with your appropriate provider to obtain it.


We accept most major PPO health insurance plans and offer competitive self-pay rates* for patients with HMO plans or without health insurance.

*See below for a list of our self-pay rates and services

Price


$80


$375


$700



$45


$200



$45



$15


$60



$20


​$95

          809B N Main St.
     Lake Mills, WI 53551
         (920) 648-2400

Physical Therapy Self-Pay Services


Treatment or Service


Physical Therapy Evaluation & Treatment


5 PT Treatment Package ($5 off/visit)


10 PT Treatment Package ($10/visit)



30 Minute Session Therapeutic Body Work*


5 Pack 30 Minute Session Therapeutic Body Work*



​30 Minute Cupping Therapy Session*



30 Minute Massage Chair


5 Pack 30 Minute Massage Chair



45 Minute Infrared Sauna Treatment


5 Pack 45 Minute Infrared Sauna


*Must be evaluated by a Physical Therapist