4660 S. Hagadorn Rd., Suite 400
East Lansing, MI 48823
Phone: (517) 355-7648
Fax: (517) 432-1319
Mon - Thu: 7am - 7 pm
Fri: 7am - 5:30 pm
Forms for your initial appointment
Lymphedema Bandage Order Forms
Your appointment time is very important to us and we will give you our undivided attention. We request your cooperation by being on time for your appointments and by having any forms, authorizations, identification, insurance information and diagnostic reports that may be necessary for your visit with us.
For Physical Therapy (PT) or Occupational Therapy (OT) we need the following:
- CURRENT physician prescription, written within 30 days of your initial visit to demonstrate need for Rehabilitation.
- Prescription should indicate: diagnosis, frequency of visits as well as duration of treatment
- Subjective questionnaire filled out prior to visit (see forms list above)
- Please arrive 15 minutes prior to appointment time to ensure paperwork is completed and insurance verification is finalized
The Rehabilitation Medicine Clinic requires at least a 24-hour notice from patients who find it necessary to cancel a scheduled appointment with one of our Physicians or Therapists. Appointments that are not cancelled 24 hours in advance will be billed $25.00, unless immediate circumstances preclude this communication. If you cancel and/or do not show for more than three appointments in a row, it is within the provider’s discretion that you may be discharged from services. Download our policies
To inquire about insurance participation, surgery benefits, co-pays and deductible, please contact your insurance carrier. For other insurance questions our staff would be happy to assist you.
Your MSU Rehabilitation Medicine clinic is not just about surviving, but THRIVING.