A prescription is a written intent for you to receive Physical Therapy given to you by your doctor. The prescription must include your name, diagnosis, doctor’s signature, and date. Many doctors will also write the number of visits they would like you to receive (frequency). You must bring your prescription to your initial visit. An Insurance Referral is a form that is required by some insurance companies. This is also given to you by your doctor’s office. If your insurance requires you to have a referral, you may bring the referral to your initial visit, or have your doctor’s office fax it to us. 3.