Thank you for your interest in Rehab Management, Inc. Therapy Services.

To help RMI prepare an accurate proposal or cost analysis of your current rehabilitation program we need some information about your current utilization and program needs.

It will be necessary for anyone requesting a pricing proposal or a profitability analysis of your current therapy services, to fill out this provided form in its entirety.

If additional information is requested, please fill out the top portion of this form along with the information box at the bottom of the page identifying what information is needed. Your requests will be responded to promptly. Alternatively you may print and complete this form and fax it to Lon Kieffer at 804-419-1566. If you have questions, please call (800) 969-9265