Patient Forms – Synapse Physical Therapy

To prepare for your first visit at Synapse, please print and complete the following forms. Medicare Patients please click on the red button below to fill out forms. Standard/Private insurance patients, please click on the blue button for your patient information forms. Please print and bring your forms on your first visit along with a valid Driver’s License or Photo ID, Insurance card and Physician Referral and/or Prescription.

Please note: If you are under the age of 18 years old, a parent or legal guardian must be present at your first appointment. Please arrive 15 minutes early to the first appointment to complete the admissions processing.

Medicare Intake Form

New Patient Form

Triage Form

We accept most insurance programs. Please see the list below for the current programs we accept. If you don’t see your carrier listed please call us directly and we can assist you with your coverage by contacting your insurance. For those patients who do not have insurance coverage, Synapse Physical Therapy offers a DISCOUNTED cash pay plan! We also accept out of network benefits for some insurances, as well as a discounted cash pay rate for patients who have exhausted their benefits. Insurance is never easy, but let us help guide you.

We recommend that you call your insurance company to verify your physical therapy benefits.

If you have questions regarding your bill, please contact our front office at 303-593-0696

INSURANCE PROVIDERS

A

AARP

AARP Medicare Complete – Optum Health

Aetna PPO (Out of Network)

Aetna Work Comp

Allsavers UHC

Align Networks

Ameriben Solutions

Anthem BCBS (Except HMP Select)

Auto Insurances

B

BCBS Federal

Beech Street

Bankers Life & Casualty

Beech Street

Blue Cross & Blue Shield

C

Casualty Management Network (CMN)

Champus

CIGNA PPO/Open Access Only

CNIC

Cofinity (OON)

CoreSource

CorVel

D

Dept of Labor Workman’s Compensation

F

Fiserv Health

First Health (out of network benefits apply)

First Health

Fortis

Friday Health Plans

G

GEHA

Golden Rule

Great West/One Health Plan

Guardian

H

Health Partners

HMO Colorado

Humana – HMO, Medicare PPO, Choice Care PPO

I

Inter Care

L

Loomis

M

Mail Handlers

Massachusetts Mutual

Medicare

Medicare Supplements (all)

MedRisk

Multi-Plan/PHCS

Mutual of Omaha

N

NALC Health Benefits

National Health Systems

New England Financial

O

Optum Health – Untied Health Care (UHC) – Pacificare

P

PacifiCare – OptumHealth

PHCS (Private Health Care Systems)

PHP and SPHP (Physician Health Partners)

Pinnacol

Principal Financial

R

Rocky Mountain Health Plans

S

Secure Horizons

See Change

St. Paul

T

Traveler’s

TriCare (Military)

U

Union Pacific Railroad Health Systems

United Health Care – Optum Health

UMR – United Medical Resource

V

VA Choice

W

Workers’ Compensation:

Including but not limited to: AIG, Aetna, Align Network (Safeway employees), CorVel-Care IQ, CCMSI, City and Council of Denver, Employers Mutual, Farmers, Federal, GE Young, Gallagher & Bassett, Hartford, Liberty Mutual, MedRisk, Nordstroms, Pinnacle Assurance – Select Net, Sedgwick, Specialty Risk Services, Tristar, Zurich