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Request an Appointment

Please do not use this form if you have an urgent medical problem or you need to reschedule an existing appointment. Instead, contact our office by phone. After you submit your request, our appointment scheduler will respond within 48 hours. See below for forms to complete and insurance information.

Patient Registration Forms

Peak & Balance Centers of America welcomes you to our practice. Once you have made your initial appointment, you may pre-register by downloading, printing, and completing the forms below. Please be sure to bring them with you to your first visit, along with any diagnostic films or other test results that may have been ordered or performed by your physician. Completing the forms prior to your visit will help speed up the new patient registration process.

Downloadable Forms:

Please note: It may take a few minutes to load the forms if you are using a slow internet connection. If you are unable to view the forms, you may need to download Adobe Acrobat for free by clicking on the icon below.

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At Peak & Balance Centers, we understand the often frustrating and time-consuming aspects of dealing with health insurance providers. As a result, we have a streamlined process that helps to make the insurance reimbursement aspect of your treatment experience a breeze.

Peak maintains contracts with the following insurance providers. To discuss individual plan coverage, please contact our corporate office.

  • Blue Cross / Blue Shield
  • HealthLink
  • Humana
  • Independent Physicians at Mercy
  • Medicare
  • The Preferred Plan, Inc.
  • Private Health Care Systems, Inc. (PCHS)
  • Tricare for Life
  • United Healthcare
  • Most major auto and workers’ compensation insurance carriers

If your insurance plan requires you to pay a co-payment, co-insurance, and/or a deductible, you will need to pay at the time of your visit. For your convenience we accept cash, checks, Visa, MasterCard, and Discover.

If you have a question related to your bill or insurance, please contact our billing specialists at (312) 646-1001.

Referral Policies/Information

You will need a referral from your physician or medical provider (primary care doctor, nurse practitioner, orthopedic surgeon, podiatrist, chiropractor, etc.) for insurance to pay for your physical therapy treatment.

Peak & Balance Centers will accept an initial referral by fax, phone, or email from your provider or you may bring the signed referral form with you to our office.

The following is an example of how we coordinate care with your physician from the beginning of treatment through your recovery:

  • Doctor diagnoses the need for physical therapy and provides a referral to Peak.
  • Patient goes to Peak for evaluation.
  • Peak sends evaluation and Plan of Care to Physician.
  • Patient receives physical therapy at Peak.
  • Peak sends Plan of Care every 30 days.
  • Upon treatment completion, Peak shares Discharge notes and Results with Physician.

After Hours Urgent Medical Needs

If you have an urgent medical need or emergency, call your doctor or seek treatment at an urgent care facility or emergency room nearest you.

Peak & Balance Centers of America