This is Pelvic Wellness Center reaching out because you either contacted us or we received a referral from your provider.

Please note: 

We are no longer accepting new patients with insurance and cannot submit claims on your behalf. However, we can provide the information needed for you to submit claims as an out-of-network provider. Please consult your insurance company for guidance. Current Self Payment rates can be found on our website: eugene.pelvicwellnesscenter.com

Unfortunately, due to Medicare rules, we are not able to accept self pay from patients with Medicare and Medicare Replacement (MedAdvantage).

After you fill out and submit this form, you have two choices:  

1)  If you want to get your questions answered with Judy Abel, PT prior to scheduling an in person appointment:  Schedule the 10 min consult to get your questions answered about how Pelvic PT can benefit you and discuss your payment options.

2) If you don't have questions and would simply like to pay out of pocket, once this form is completed contact us via text or phone 541.515.6215.  We will send you the rest  of the forms and then you can simply schedule your own in person appointments so we can get you in sooner.

To get started: 

Simply copy the red password below then open the form and insert the password.

Please call or text anytime 541.515.6215 if you have any questions.

You can also visit our website for more info: https://eugene.pelvicwellnesscenter.com

I look forward to talking with you soon.

[IntakeQLink]

Judy Abel, PT