Download - Metro Chinese Weekly | 海华都市报 #476C
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C PHILADELPHIA | | |
CULTURE
DINING
ENTERTAINMENT
HEALTH
20160318 03/18/2016-03/24/2016
www.MetroChinese.com
476
Phone: (610) 617-8800 Fax: (610) 482-9220 [email protected] Address: 167 Old Belmont Avenue, Bala Cynwyd, PA 19004
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Patients Name: ____________________________ Patient Phone: __________________________
Referring Doctor: _______________________ Phone: _________________ Fax: _______________
Referring for: Physical Therapy Balance Rehab Chronic Pain Education
Body Mechanic Education Other: ________________________
We accept Health Partners, Medicare, Keystone VIP Choice, Keystone First, Cigna Bravo, United Healthcare Community Plan,
Aetna Better Health, IBX, BCBS, Tricare, and other insurances
*
Reasons For Medical Necessity For Physical Therapy Treatment
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