(817) 410-7777
PATIENT RESOURCES
FORMS
Please click on the forms to view in PDF.
PATIENT FORMS
New Patient Paperwork for Dr. Cox
New Patient Paperwork for Physical Therapy
Update Patient Paperwork for Dr. Cox
Update Patient Paperwork for Physical Therapy
Medical Release Form
PHYSICAL THERAPY RESOURCES
Bladder Diary
Bladder Retraining
Urge Suppression
Foam Roller: Front of Thighs
Foam Roller: Back of Thighs
Foam Roller: Goddess
Foam Roller: Inner Thigh/Groin
Foam Roller: Latissimus Dorsi Release
Foam Roller: Piriformis & Gluteal Muscle
Foam Roller: Side Hip Roll- Iliotibial Band
Foam Roller: Upper Back Release
INSURANCES WE ACCEPT
Accountable Health Plan
AETNA Commercial
AETNA Medicare PPO & HMO
BCBS HMO
BCBS Premier HMO – will be effective soon.
BCBS PPO/POS
BCBS Medicare PPO
Beech Street – Consumer Savings Card
Beech Street – PPO
Bravo HealthTexas Medicare
Care Improvement Plus Medicare
ChoiceCare (Humana) – Concentric (Humana Preferred)
ChoiceCare (Humana) – Medicare Advantage HMO
ChoiceCare (Humana) – Medicare Advantage PFFS
ChoiceCare (Humana) – MedicareChoice PPO
ChoiceCare (Humana) – PPO
CIGNA – HMO/PPO
Coventry Advantra MedicareAdvantage PPO
FedMed – PPO
FirstHealth/Coventry Network – MedicareAdvantage PPO
First Health/Coventry Network – PPO
Galaxy Health Network – Medical Savings Card
Galaxy Health Network – PPO
HealthSmart – ACCEL
HealthSmart – GEPO
HealthSmart – PPO
Independent Medical Systems (IMS) – PPO
Plan Vista – PPO
Prime Health Services
Texas Bluebonnet – EPO/HMO/PPO – will be effective soon.
UnitedHealthcare – ACO
UnitedHealthcare – HMO/PPO
UnitedHealthcare Select Navigate Plus – requires referral
UnitedHealthcare MedicareAdvantage PPO/HMO
We are proud to be one of only a handful of clinics that offer a full range of surgical and non-surgical options to treat the entire spectrum of problems that can affect pelvic floor, colon, and rectum.
CONTACT
300 S. Nolen, Suite 100
Southlake, Texas 76092
Phone: 817.410.7777
Fax: 817.410.9906
AFFILIATIONS
Methodist Southlake
Grapevine Surgicare
Baylor Medical Center at Grapevine
SUPER DOCTORS
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