Home

What we do

Who we are

Patient Information

Links

Locate Us

In the Know /In the News

Patient Information

The following forms are available to print and bring to your first office visit.

Registration Form
Medical History
Physician Referral Form
Notice of Privacy Practices

Midwest Rehabilitation Inc. has experience in working with a large number of insurance providers. However, we do not  accept Medicare or Medicaid/Public Aid at this time. It is the patient’s responsibility to verify insurance coverage prior to your visit. To learn more, please contact our office at (217) 522-3380 or check with your insurance company.

First Visit Questions

Q. What should I wear to my therapy session?

A. Please wear loose-fitting, comfortable clothing and shoes. Your therapist will tell you if different clothing is required. 

Q. What should I bring with me?

A. You should bring:

• The Physician prescription or the Physician Referral Form, filled out and signed by your doctor.
• Notes, reports, x-rays or other test results from your doctor.
• Insurance information
• Braces or prosthesis
• (Optional) completed patient registration and medical history form

Medical District Location

Midwest Rehabilitation Inc.
614 North Sixth Street, Suite A
Springfield, Illinois 62702
Fax (217) 522-3382
Phone (217) 522-3380

West Location

Midwest Rehabilitation Inc.
2717 W Monroe
Springfield, Illinois 62704
Fax (217) 787-8723
Phone (217) 787-8720

Copyright (C)
Midwest Rehabilitation Inc.

Contact us by E-Mail at:         midwestrehab1@sbcglobal.net