UNVERSITY HEALTH CENTER
The University of Georgia
Athens, GA 30602-1503
(706) 542-8634
NAME: ___________________
UGA ID#: _________________
GENDER: _________________
DOB: _______________
Health Insurance and Physical Therapy
All students, regardless of whether they have health insurance or what actual type of insurance they
have, are eligible to receive physical therapy at the University Health Center. In comparison to other
clinics in the area, our visit costs are on average about 50% less. Our sessions are individualized one-onone care to incorporate both treatment and education. PRIOR to filing with insurance, the initial
appointment will be about $125, and about $90 for each follow-up visit. Please note: all charges are
based on what specific interventions are performed during a particular physical therapy session.
Many health insurance companies have begun requiring pre-certification for Physical Therapy
services, so as the patient, YOU are responsible for contacting your health insurance company to
verify Physical Therapy benefits and if Pre-Certification is needed before continual treatment. Failure
to obtain Pre-Certification, if needed, can result in penalization from your insurance company. This
means your insurance company is not responsible for paying the incurred charges. Once you have
spoken with your insurance company, please call our office to inform us of any information you were
given regarding your coverage and Pre-Certification.
*Any charges not Pre-Certified or covered by health insurance are the patient’s responsibility to pay.*
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Before Your First Appointment You Agree to….
Contact your insurance as stated above
Complete the online questionnaire
Wear appropriate clothing (i.e. exercise clothes, tennis shoes, etc.). If we are seeing you for a
neck/upper back/shoulder issue, a tank top is preferable. If we are seeing you for a
hip/knee/ankle issue, please wear shorts.
Please arrive ten minutes prior to your appointment. If this is your first appointment at the
Health Center or if any of your information has changed, stop by Registration prior to checkingin for your PT appointment.
There is a $30 charge for missed appointments or appointments canceled less than 24 business hours
in advance. Please call (706) 542-8634 to reschedule.
By signing below, I acknowledge that I have read and understand all of the above information.
Signature of Patient __________________________
Print Name _________________________________
Date __________________________