Forms and Paperwork

If you have any questions or concerns about your paperwork, please call us at (410) 970-2400. All forms below are PDFs, and must be downloaded and completed electronically or by printing and filling them out. Please make sure you fill out the forms with as much accurate information as you can.

Note: The medical history/physician referral form must be completed and signed by the referring physician PRIOR to your first visit. If you wish to go through your insurance for payment of services, you must also have a separate script for the type of therapy to be received (ie PT/OT/SPEECH, "Evaluate & Treat") as required by most insurance companies for proper reimbursement of services.

Please take the time to review our HIPAA Compliance Policy & Notice.

Completed forms can be faxed to (410) 774-4090 or emailed to info@unbridledrehab.com. Thank you!