Physical Therapy Guide to Lymphedema - ChoosePT 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the 'Date of Submission' at the top of the form. This is crucial for tracking your request.
3. Fill in the 'Previous Reference/Auth Number' if applicable, followed by selecting the 'Service Type Requested'—either Physical Therapy or Occupational Therapy.
4. Complete the 'Patient' section with details such as First Name, Last Name, DOB, Gender, and contact information including Home and Cell Phone numbers.
5. In the 'Provider' section, input the provider's name, specialty, and contact details to ensure proper communication.
6. Indicate the 'Diagnoses' and provide relevant clinical information including treatment phases and lymphedema stage. Be sure to select all applicable options.
7. Finally, review all entered information for accuracy before submitting your form through our platform.

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