Insurance & Forms


Lisa Schroeder Physical Therapy Martha's Vineyard can directly bill Blue Cross Blue Shield of Massachusetts and Medicare for your physical therapy services. Other insurance plans can also be billed provided you have out-of-network coverage. Lisa works closely with her billing service to acquire payments, so that you don't have to. A self-pay option is also available. Please contact Lisa for assistance in determining your coverage and to discuss your payment options.


Lisa values the importance of your time. To best accommodate you, these forms may be filled out before your first visit. Click "Download Forms" below to download all three and print. Please fill out as completely as you are able and Lisa will assist you with any areas that you may have questions about. If you don't have a printer Lisa will bring forms on her initial visit.

HIPAA Privacy Authorization Form • HIPAA (Health Insurance Portability and Accountability Act) Privacy Authorization Form: this form is required and ensures the security and privacy of your health data.

Insurance Verification Form
 • please fill out personal information sections and fill out policy numbers as shown on your insurance card. Lisa can assist you in calling for verification and pre-authorization of your benefits if needed.

New Patient Intake Form • this form gathers basic personal and contact information about the patient and his/her insurance coverage.

Download Forms