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Wheelchair Clinic Referral Checklist

Our insurance-based outpatient wheelchair clinic is the highest volume clinic in the state of Rhode Island, assisting hundreds of individuals each year. We would love to help your patients get the mobility and positioning equipment they need. To expedite scheduling, please see what makes a complete referral below. 

Build the Referral 

Please note that we are IN NETWORK with Medicare, Neighborhood Health Plan of Rhode Island, and all Blue Cross Blue Shield Products. We offer a discounted private pay rate for individuals with Out of Network Insurance and offer a Superbill upon request. Unfortunately, we do not take individuals with United Healthcare products at this time. 

Physical Therapy Prescription

Please include a prescription or order for a physical therapy evaluation and associated follow up visits to determine and trial the most appropriate equipment. Include any relevant diagnoses. 

Patient Demographics

Please attach a face sheet or demographics page with the patient's name, date of birth, phone number, address, insurance (and policy number if possible)

Other Relevant Information

If you have a specific request or comments, feel free to include other documentation to assist our therapists in obtaining a complete picture. If you know your patient cannot travel to the clinic and needs to be seen in their home, please make a note. 

Fax It

Please fax your complete referral to (401) 804-1550. If you have any questions, email, or call (401) 903-2433.

Want an adaptABLE prescription pad to make referrals fast? 
Fill out the contact form below, and let us know where we should send it!

Prescription pad with categories for more information to aid primary care providers in making clear referrals. Categories include the patient name, relevant diagnosis codes, and specific types of equipment the patient may need to be evaluated for, such as manual or power wheelchairs, shower seating, standing frames, or transfer lifts.
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