Patient Forms

Below are the most commonly-requested forms. If you’re a new patient preparing for your first visit at Bellingham Physical Therapy, feel free to print and complete the following forms from the comfort of your home: Patient Intake Form, Billing Information, Notice of Privacy Practices, Authorization to Speak to Others, and the Medicare Payment Authorization (if applicable).

Patient Intake Form
Download Form

 

Billing Information
download

Notice of Privacy Practices
Signature Form
download

 

Medicare Payment Authorization
Signature Form

Download Form

Authorization to speak to others
regarding patient's medical team
Download Form

 

HIPAA Notice of
Privacy Practices
Download Form

 

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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