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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


You will need Adobe Reader to read and print out our forms.
To download the free Adobe Reader program, click the icon below. The Adobe website will open in a new window.
get adobe reader


We're always out and about in the Community. Find out what your PT has been up to lately...

Make an Appointment

Call us today to schedule an appointment
Phone: (360) 647-0444

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

Learn How We're Making a Difference.

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