Jordan Singh

 
 TOWER PHYSICAL THERAPY, INC. 
 Private Insurances: Any insurance that does not pertain to a work injury. 
 Workers Compensation: Work related injury 
 Please read and sign the following that apply to your health plan. 
 PRIVATE INSURANCE/MEDI-CARE Any insurance that does not pertain to a work injury. 
 If you are not aware of your physical therapy benefits, please let us know and we will acquire 
 them for you, otherwise we will assume you are aware of your benefits. 
 Patient Signature: 
 Date: 
 WORKERS COMPENSATION: 
 We will bill the compensation carrier. 
 Patient 
 Signature: Ed Foster 
 Date: 2021-16-03
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