Texas Board of Physical Therapy Examiners
333 Guadalupe, Ste 2-510
Austin, Texas 78701-3942
Physical Therapy Treatment without Referral Disclosure. Please read carefully and acknowledge below:
- I understand that physical therapy treatment without a referral will be based on the physical therapist’s examination and evaluation of my current condition which may result in identification of movement and mobility dysfunction.
- I understand that the physical therapist will not diagnose an illness or disease, and that physical therapy is not a substitute for a medical diagnosis.
- I understand that if a medical diagnosis has already been established by a qualified healthcare practitioner, the physical therapist will take it into consideration during the evaluation process.
- I understand that the physical therapy plan of care developed by the physical therapist may not be based on radiological imaging.
- I understand that if images have previously been obtained, the physical therapist may use the information as part of the evaluation process.
- I understand that if the physical therapist identifies a need for radiological imaging, the physical therapist may recommend that radiological imaging be obtained.
- I understand that my health insurance may not cover physical therapy services if provided without a referral from a qualified healthcare practitioner.