Phone Number: 580-226-5566

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Forms

 

New Patient Forms

Admission Form

Adult Intake Form

HIPPA Form

Child Hearing Loss Intake Form

Speech Language Intake Form

Parental Consent form SC-15

Change of Provider Request SC-16

New Hires

W4 2017

2014 W9

Direct Deposit Form

New Hire File Info

PRN Agreement

Criminal History Consent and Release

Benefits Application for New Hires

Prohab PRD

WELCOME GUIDE from United Healthcare

United Healthcare

United Healthcare Enrollment Form

Dental and Vision Rates

Health Insurance Bi-weekly payroll deductions 2017

PHARMACY BENEFIT INFORMATION

Delta Dental Enrollment Form

Delta Dental Program Highlights

Summary of Benefits and Coverage $500 deductible

Summary of Benefits and Coverage $1000 deductible

Met Basic Life Summary

Met Vision Enrollment Form

Met Vision Summary

Transamerica Application

 

 

Prohab Therapy Specialists

1107 W Broadway St
Ardmore, OK 73401
Phone: 580-226-5566
Fax: 580-226-5567

Tulsa Outpatient Clinic

7711 E. 111th St. S., Ste. 127
Tulsa, OK 74133
Phone: 918-691-3212
Fax: 918-364-4276

Physical Therapy

Occupational Therapy

Speech Therapy

Payment Options

We are Medicaid providers and are credentialed with most private insurance companies. Fee for service is available as well as payment plan options.

Therapy Specialists

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