New Patient

Thank You for choosing Santiam Physical Therapy! Please complete the New Patient Intake Information Forms (Including your insurance information) and the Patient History form and bring them with you to your first appointment. Please arrive 10-15 minutes early for your first appointment.

*If you do not have insurance benefits please complete the Self Pay Agreement and include it with your other Intake Information and bring it with you to your first appointment also.

*If you have been involved in an automobile accident, and we are billing 3rd party you should complete the Medical Lien by taking it to your attorney. You and your attorney must sign and date the document. Please note that the document will not be accepted if it is altered. Please bring this with you, along with the other intake information to your first appointment. We will not bill for a 3rd party without the Medical Lien signed and dated.

*If you have any questions please call us at (541) 258-8222

New Patient Process

New Patient Process

Please review and fill out the new patient paperwork online before your first appointment.

Accepted Insurances

Please contact us at (541) 258-8222 to determine our provider status with your insurance company. We cannot list all insurances which have given us provider status, so please check with us so we can determine eligibility together.   At times insurance companies do not list all providers in their written or online material. All the more reason to check with us first.


Private Insurance: Coverage of physical therapy is included in most insurance policies, however, deductibles, percentages and co-pays vary. As the insured is ultimately responsible for payment, you should check your specific policy for coverage details. We will do our best to help you determine your level of coverage. We will gladly bill your primary insurance company.

Workers’ Compensation: Before initiating physical therapy, we must obtain specific claim information including your claim number, date of injury, claim manager contact information, etc. If your claim in pending or deferred, be aware that payment could become your personal responsibility if the claim is denied. Once therapy begins, it is extremely important that you follow through with your physical therapy program. Failure to comply with your program may mean a suspension of or cancellation of your benefits by the insurance provider.

Medicare: Our office accepts Medicare Assignment which means our clinic will accept the Medicare approved charge as the full charge for covered services. Medicare will then pay 80% of the approved charge. The beneficiary or their Medicare Supplement is responsible only for the 20% Medicare does not pay plus any unmet deductible. Our clinic bills Medicare directly. You must have a referral from your doctor for physical therapy.


  • Auto Claims
  • Workers Compensation
  • AARP
  • Aetna
  • Blue Cross Blue Shield
  • Champus
  • Cigna
  • Cypress
  • First Choice Health Network
  • Lifewise
  • Medicare
  • Moda Health
  • Mutual of Omaha
  • Pacific Source
  • Providence
  • Regence
  • Samaritan Health
  • Tricare
  • Triwest Healthcare Alliance
  • United Healthcare
  • Veterans Administration

We bill auto claims for Personal Injury Protection claims (PIP) coverage. We do not bill 3rd party claims.

Want to save time? Download our Insurance Information Release Form HERE and bring the completed form with you when you visit our office.

HIPAA Privacy Policy

Santiam Physical Therapy

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Santiam Physical Therapy is committed to protecting the confidentiality of your medical information and is required by law to do so. The Notice of Privacy Practices describes how we may use and disclose your protected health information to carry out treatment, payment of health care operations, and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information.

We are required by law to:

  • Make sure that health information that identifies you is kept private.
  • Give you this notice of our legal duties and privacy practices with respect to health information about you.
  • Follow the terms of the Notice that is currently in effect.

How we may use and disclose health information about you:

  • For treatment.
  • For payment.
  • For health care operations.
  • As required by law.
  • Public Health risks.
  • Health oversight activities.
  • Lawsuits and disputes.
  • To avert a serious threat to health and safety.
  • Inmates.
  • Workers Compensation.

Your rights regarding Health Information about you:

  • Right to inspect and copy.
  • Right to amend.
  • Right to accounting of disclosures.
  • Right to request restrictions.
  • Right to request confidential communications.
  • Right of a paper copy of this Notice (the entire Notices is available upon request)

If you have a question or complaint:

  • For a complete copy of the Notice of Privacy Practices, please request one from the front desk and we will provide you with a complete copy.
  • If you have questions or concerns or complaints about the Notice or your medical information, please contact our office and they will further assist you.
  • You will not be penalized for filing a complaint.

Changes to this notice:

  • We have the right to change our practices regarding the protected health information we maintain. If we make changes, we will update this Notice.
New Patient Forms

If you are a new patient, please fill out the form below before your first appointment. This allows us to get you checked in quicker, and gets you into your first appointment sooner. Alternatively, you can download the form and fill it out by hand.