Patient Forms
- History Form - If you are a new patient or have not been seen in 1 year
- Patient Status Update- If it has been more than six months since your last visit but less then a year
- Personal Injury History - If you have been in a car accident, slip and fall, etc.
- Work Compensation History - If you have had a work injury
- Back Bournemouth - If you have back problems
- Neck Bournemouth - If you have neck problems
- Headache Disability Index - If you have headaches
- Lower Extremity Functional Scale - If you have hip, knee, leg or foot problems
- Upper Extremity Functional Scale - If you have shoulder, arm, elbow, wrist, or hand problems
- FABQ - If you are out of work due to an injury
- Pediatric History - Children under three
- Female Health History
- Medication/Supplement List - Any changes to your medication, please reprint and submit to us.
Insurance and Billing
The insurance plan is an agreement between the subscriber (usually the patient) and the insurance company. Our staff attempts to determine our patient's insurance coverage specifics but we are not always given the correct information by the insurance company. Patients should bring their insurance plan book with them on the first visit if they have additional questions.
Please understand your employer has the ability to purchase an insurance plan tailored to their specifications that may be unique to them.
Although it is not possible for The Hetrick Center to be familiar with all the different types of plans and coverages we make every attempt to verify coverage with your insurance company. We rely on the insurance provider to give us the correct information; however, that sometimes does not occur. Because errors do occur, it is the patient's responsibility to know their insurance plans specific benefits.
If you have any additional concerns, please feel free to ask to speak with a member of Management.
Thank you for allowing us to provide you with quality healthcare services.
Patient Resources
CareCredit®
We offer affordable solutions at The Hetrick Center. CareCredit is a healthcare credit card designed for your health and wellness needs. It's a way to pay for the costs of many treatments and procedures and allows you to make convenient monthly payments. CareCredit is accepted at over 200,000 locations nationwide, including The Hetrick Center.
Links
Products
- Accommodators: Orthotic used to assist in stabilizing the feet to allow proper mechanics in walking and standing. This helps to decrease pelvic, low back, knee, ankle, foot pain, and dysfunction.
- Biofreeze®: A topical analgesic that is used as a fast-acting, long-lasting pain reliever. Biofreeze® can be used to help relieve pain caused by sore muscles, muscles strains, arthritis, and pain in the neck, back, elbows, shoulders, hips, knees, and ankles.
- Braces: Used for the support of the spine, elbows, wrists, knees, and ankles. The brace is used to provide stabilization to the inflamed or painful area of complaint.
- Cervical Support Pillows: Designed to provide restful, comfortable sleep with proper neck support, allowing for sufficient stabilization of the normal cervical curve.
- Chiro Flow® Waterbase Pillows: Proper neck support can help relieve pain and discomfort. Water is added to the pillow for variable resistance.
- Exercise Balls: Used to develop overall control and strength of the core muscles. The exercise ball helps with improving low back mobility, balance and stability, proprioception and developing postural awareness and strength.
- Thera Bands: Elastic thera-bands which come in different colors indicating different levels of resistance to improve muscular strength, endurance, range of motion and promote flexibility.
- Gift Cards: The perfect gift for a friend or family member is to tell them you care by providing them a gift card to be used towards massage therapy, gym membership, a visit with a personal trainer or towards nutritional supplements.
- Heating Pads: Can be used to manage pain by warming a part of the body. Heat causes dilation of blood vessels, improving the nutrient flow to the area and promoting relaxation.
- Heel Gel Cups: Provide shock prevention and are softer, lighter, and more resilient than standard heel cup material. Heel gel cups are useful in preventing heel sores.
- Heel Lifts: Shoe insert designed to restore proper balance of weight by assisting in correcting a leg length discrepancy. This can help reduce low back and pelvic dysfunction and pain.
- Gym Memberships: Joining The Hetrick Center Gym allows individuals to have full access to cardio, weightlifting, and band resistance exercise equipment. Working out in our health care facility adds to the workout experience by having trained professionals on staff to ensure exercises are being done properly, answer questions gym members may have about stretches or exercises, and provide progressive exercise ideas to keep your gym program interesting and moving forward.
- Handmaster: This unique exercise ball is designed to improve grip strength, muscle balance of the hand, and speed and stamina of the hand. What makes this piece of equipment unique is that it is small, easy to use, and works all of the muscles in the hand.
- Heat/Ice Packs: These unique heat/ice packs can be used to cool or heat a specific body part.
- Leg Spacer®: This positioning support cushion helps reduce pressure and strain on the low back, knees, and ankles.
- Lumbar Support Cushion: Provides low back support while driving, sitting or resting. Easy to use with any chair to help you maintain good posture.
- Orthotic Products: These custom made orthotics are specialized shoe inserts used to help severe heel pain, shin splints, flat feet and some types of knee or hip pain. Analysis of foot structure, gait analysis, and functional activities can benefit from custom made orthotics.
- Overhead Pulleys: Helps to increase range of motion of the shoulder and scapula.
- Over-the-door Traction Units: Commonly used to decompress the neck to relieve pain related to muscle spasms and pain from pinched nerves in the neck.
- Sissle® Sitfit®: Inflatable disc that can be used for low back exercises, lumbar stabilization, and lower extremity kinesthetic exercises to improve proprioception.
- Tens Units: Portable electrical stimulation units that can be rented or purchased. The tens unit is used to decrease pain and promote healing.
- Tens Pads: To be used with the portable electrical stimulation units.
Testimonials
The Hetrick Center knows how to treat because they listen first.
I am so pleased with my results! The staff listened to my concerns and that made all the difference.
The personalized attention sets The Hetrick Center apart from the rest.
It was a pleasure to come in and be taken care of by professional people.
I have been in many rehabs in the past 3 years and the staff at The Hetrick Center has improved my past limitations better than anywhere else.
The Hetrick Center has provided me with the motivation and positive reinforcement needed to continue with my Physical Therapy even when it got hard. The combination of pool therapy and land therapy has helped me more than just land therapy alone.
It makes such a difference to walk in the door and be greeted by name!
I always know I will get top-notch professional care from the outstanding staff at The Hetrick Center.