New Patient Information
How to Obtain Services
We require a referral from your doctor to schedule an appointment. Referral forms are located below. Completed referral forms should be faxed to 860-748-4432. We accept most insurances – including Husky! For any questions on scheduling or the referral process please contact us at 860-270-0600 x100 or medrehab@escrec.org.
To learn more about our specialized services, upcoming dates, and to register, click here.
You can learn more about our providers here.
Brochures & Forms
Referral Forms
Medical Rehabilitation Brochures & Handbooks
- Medical Rehabilitation Programs Brochure
- Medical Rehabilitation Health Assessments
- Patient Handbook: English Spanish
- Patient Handbook & Orientation Checklist
- Patient Bill of Rights
- Patient Responsibilities
- Program Measurement & Management Report
New Patient Forms
- Emergency Contact & Medical Information Form
- Service & Fee Agreement Form
- Confidentiality, Privacy, and PHI Form
- Medicare Attestation of Home Health Care Service
- Telehealth Consent
- Legal Document for Guardianship
- Authorization to Release/Obtain Health Information Form
- Consent for Neuropsychological Services
Surveys
- Patient Satisfaction Survey for Physical Therapy, Occupational Therapy, Speech Therapy, or Social Work
- Stakeholder Satisfaction Survey for Physical Therapy, Occupational Therapy, Speech Therapy, or Social Work
- Patient Satisfaction Survey for Neuropsychology Services
- Stakeholder Satisfaction Survey for Neuropsychology Services
