Patient Forms

We’ve made available several of our commonly-requested forms on this page. If you’re a new patient preparing for your first visit at Bellingham Physical Therapy, feel free to print and complete our registration and notice of privacy practices signature form from the comfort of your home.

Patient Intake Form 1
Download Form


Patient Health Survey
Download Form

Billing Information


Medicare Payment
Authorization Signature Form
Download Form

Authorization to Use &
Disclose Patient Information
Download Form


HIPAA Notice of
Privacy Practices
Download Form


Notice of Privacy
Signature Form

Insurance Verification

Download Form


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Phone: (360) 647-0444

306 36th Street Bellingham, WA 98225
(By the REI in Sehome Village)

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