Telehealth Services

Due to the current COVID-19 pandemic, my physical office locations are temporarily closed. In the mean time, I am available for consultations via the link above if you are having any aches or pains that do not warrant an emergency visit. New patients will get 40 minutes at cost of $50 and current patients will get 20 minutes at cost of $20. This platform allows us to go through video camera so I can see you move for an evaluation, and you can see me move for exercise demonstration. This way, I am able to show you how to treat yourself through safe movement and exercise.

Please see the below consent form prior to scheduling a telehealth appointment - please call, text, or email to schedule as you would a regular appointment.


Informed Consent for Telehealth Consultations


To better serve the needs of people in the community, health care services are now available by interactive video communications
and/or by the electronic transmission of information. This may assist in the evaluation, diagnosis, management and treatment of a
number of health care problems. This process is referred to as “telemedicine” or “telehealth.” This means that you may be evaluated
and treated by a health care provider or specialist from a distant location. Since this may be different than the type of consultation
with which you are familiar, it is important that you understand and agree to the following statements.


1. The consulting health care provider or specialist will be at a different location from me. A physician or other health care provider
(“presenting practitioner”) may be present with me in the room to assist in the consultation.
2. The presenting practitioner may transmit or share electronically details of my medical history, examinations, x-rays, tests,
photographs or other images with the specialist who is at a different location.
3. I will be informed if any additional personnel are to be present other than myself, individuals accompanying me, the presenting
practitioner and, via video, the consultant. I will give my verbal permission prior to the entry of the additional personnel.
4. The physician or health care provider for whom the on-site examination or treatment is performed (that is, the “presenting
practitioner”) will keep a record of the consultation in my medical record.
5. RELEASE OF INFORMATION: Muscle Up Physical Therapy Wellness, P.C. and/or physicians who provide professional services to the patient are authorized to
furnish medical information from my emergency medical record to the referring physician, if any, and to any insurance company
or third party payer for the purpose of obtaining payment of the account. Muscle Up Physical Therapy Wellness, P.C. is authorized to release information from my
medical record to any other health care facility or provider to which my care may be transferred.
6. I voluntarily consent to health care services provided by my doctor(s) or a designee, which may include diagnostic tests, drugs,
examinations, and medical or surgical treatments considered necessary to treat my health problem.
7. I understand that I may be released before all my medical problems are known or treated and it is my responsibility to make
arrangements for follow-up care.
8. I understand that I have the option to refuse telehealth service at anytime without affecting the right to future care or treatment.


ASSIGNMENT OF BENEFITS
I agree to pay, in a timely manner, for physical therapy care services provided. 


FINANCIAL RESPONSIBILITY
In consideration for the telehealth services rendered to me, I agree to pay the charges to Muscle Up Physical Therapy Wellness, P.C. Should my account be referred for collection, I agree to pay Muscle Up Physical Therapy Wellness, P.C. reasonable attorney fees and collection expenses.

*You will be given this same statement and asked to agree with a "YES" response before we start your appointment!

You will be sent an invoice from Square to your email on file that is expected to be paid ASAP.


TEXT/ CALL: (585) 721-0668

EMAIL : Kelsey@muscleuppt.com

Appointments required, no walk-ins

See Schedule for days and times available - if times don't work please reach out to get a separate time scheduled


PENFIELD

(inside Perform Athletix, CrossFit ATX)

1601 Penfield Rd, Rochester, NY 14625

DIRECTIONS: In the back of Panorama Plaza - go in to the entrance off Panorama Trail behind Bruegger's Bagels, once in the parking lot pass Verizon on your left, then at the stop sign is the entrance to the CrossFit gym. Walk into the waiting room to the right, down the hallway my office is the second door on the right.


GATES

(inside CrossFit Ambition)

2147 Buffalo Rd, Rochester, NY 14624

DIRECTIONS: Take exit 7A of 490, after about 1/4 mile take a right onto Pixley Rd, then turn left into the Big Lots parking lot, go past the Big Lots store front towards the back corner on the same side of the plaza. Once in the CrossFit Ambition doors, turn left to find the member lounge where my office is located.

 

Telephone: (585) 721-0668
Email: Kelsey@muscleuppt.com

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