Referral for Rehab

Insurance coverage for Physical Therapy requires a Physicians Referral (Rx) to begin evaluation and treatment for any injuries or impairments. Your doctor can fax their Rx to us at 619-466-6077 La Mesa Rehab, or complete this online form below. All patients should come dressed for therapy, with tennis shoes and comfortable, non binding clothing.

Print a Referral Form for your Doctor

Download

Patient Registration Forms

Download

Respiratory Questionnaire

Download

Ask your doctor to fill out the form below and we will respond promptly.

Patient Name

Physician name

Physician Office Phone

Your Email

Date of Birth

Patient Name

Type Insurance (if not in the list above)

Diagnosis

Message

PLEASE FAX PATIENT DEMOGRAPHICS AND PHYSICIAN NOTES TO US AT
619-466-6118 WITH THIS REFERRAL. THANK YOU.