Get In Touch

Please be aware that Connection Physical Therapy is not in network with any insurance providers.

Treatments for specific conditions such as Temporomandibular Joint Dysfunction (TMJ) & Ehlers-Danlos Syndrome (EDS) are often excluded from standard insurance coverage.

To facilitate your access to care, Connection Physical Therapy offers services as an out-of-network provider.

Upon request, a receipt of services (superbill) may be provided which you can submit to your insurance company for potential reimbursement under your plan’s out-of-network benefits. Payments from HSA/FSA’s are accepted.

Call for a free 15 minute consultation.

503.828.1743

Name

First Name

Last Name

Subject

Message

RATES:

Cash/Card

60-75 Minute Evaluation: $200

55-60 Minute Follow Up Treatment: $150

Patient Referral Form

Please use the below link to refer a patient to Connection Physical Therapy.

Connection Physical Therapy Referral Form

Patient Name

First Name

Last Name

Date of Birth

Phone Number

ICD-10 Codes/Diagnosis

Email Address

Physician First and Last Name

First Name

Last Name

Signature Confirmation

I understand that checking this box constitutes a legal signature for my name listed above confirming that I acknowledge and agree to the above referral to Connection Physical Therapy.

Phone Number

Fax Number

Email Address

Get In Touch

Call for a free 15 minute consultation.

503.828.1743

RATES:

Patient Referral Form

Location

Hours

Contact