Patient Forms

To save time during your office visit please download, print, complete, sign and bring with you the patient forms below:

• Kimbia Physio, LLC-Medical History Questionnaire
• Kimbia Physio, LLC PERFORMANCE COACHING-TRAINING WAIVER  (Performance Sport Systems participants must complete)

Insurance Information (Out of Network). While I do not bill your insurance company directly;

• You may claim Kimbia Physio as an Out of Network Provider.  Most insurance companies will provide these forms online. Please contact your insurance company to inquire about specific benefits.
• Treatment charges may be applied to your deductible.
• Reimbursements from your insurance company go directly to you in the form of a check in your name.
• Payment for services are due at the end of each session. KimbiaPhysio LLC will provide you with a detailed invoice for your records and to submit to your insurance company.