The staff at Excelsior Springs Hospital is pleased you have chosen us as your therapy provider. We welcome the opportunity to provide you excellent care and to assist you with your rehabilitation needs.

Consistency in your rehab team is important to us. Please understand that staff illness, vacations, insurance requirements, or even your own scheduling conflicts may warrant a time slot where you may need to be treated by a staff member that is not your primary therapist. We are affiliated with several therapy education programs, and provide internship opportunities for therapy students. By signing this you are consenting to allow student therapist to be involved in your care. Each student is directly supervised by a staff therapist who will be involved in all treatment decisions/care provided. Rest assured that precise documentation of each visit is made so that all staff is well aware of your condition, your previous treatments, goals, etc.

We strongly believe that a consistent progression in your condition is in part due to the home exercise program provided to you by your therapist. You will frequently be instructed on detailed techniques, positions, and exercises to be performed at home. It is important to your progress and recovery to complete these as directed by your therapist.

Please inform your therapist in advance of when you return to your referring physician for follow up so that reports can be sent in a timely manner.

Your therapist will recommend a special treatment plan, including a specific number of treatments per week. Attending all of these visits is crucial to your rehabilitation. While it is understood that unforeseen issues and circumstances will occur from time-to time, appointment no-shows or last-minute cancellations will not only hinder your recovery, but will also negatively impact other patients looking for appointment times.  Our Cancellation & No Show Policy is as follows:

Patient Action Time Frame Grace Period Charge
No Show Day of Appointment None $25 Each Occurrence
Cancellation Day of Appointment 2 Occurrences $25 Each Occurrence after Grace Period
Cancellation Prior Day (s) n/a None
Reschedule Appt. Day of Appointment 2 Occurrences $25 Each Occurrence after Grace Period
Reschedule Appt. Prior Day (s) n/a None

You may be discharged at the discretion of your therapist if your scheduled appointments are routinely cancelled. If you no show for 3 consecutive appointments without calling, you will be discharged, billed $25 for all 3 occurrences and all remaining appointments will automatically be cancelled.

I want to personally welcome you to our facility. If any problems arise with any aspect of your care, I strongly encourage you to contact me at 816- 629-2770. Please don’t hesitate to ask me, or your therapist, if you have any questions.


Christy Marker, PT  Director of Rehabilitation Services

Client Signature: ________________________________

Date: __________________