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
download

 

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

download
Insurance Verification

Download Form

 

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News

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Phone: (360) 647-0444

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


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