Patient Intake Form

At Northern Physical Therapy & Fitness, we want to maximize your time with us. Prior to your first visit, please fill out the New Patient Intake form below and submit it. Also bring along proof of ID along with your insurance information.

PRIVACY STATEMENT
Please note that no personal information from this form will be stored on our website database. All information is securely directed and saved in our clinic’s Electronic Medical Record (EMR) system where all data is encrypted. The patient information will only be used by the clinic and will not be passed on to any third party.

Click here for Notice Of Privacy Practices

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Patient Forms

Expedite your check-in! Print and fill out the relevant forms, and bring them with you when you arrive for your first appointment. Your already-short wait time will be reduced even further!