Patient Resources

New Patient Forms

In order to better meet our patients’ needs we have included a link to our registration form. Click on the link and print and complete the form prior to coming into the clinic for your initial evaluation.

New Patient FormHIPPA NoticeConsent FormMassage Therapy Intake FormNeck Disability IndexLower Back Pain Disability QuestionnaireUpper Extremity QuestionnaireLower Extremity QuestionnaireDizziness Handicap InventoryJaw Pain ScaleSelf-Treatment For TMJ Jaw PainFoam Roller Instructions

Pay Your Deductible/Co-Pay Online

We accept payments in the form of cash, check, Visa, Mastercard, or Discover at each of our clinics. For you convenience, we also accept online payments via PayPal. As always we appreciate your business and prompt payment.

If you have any questions, please contact us at 815-756-8524.

By clicking the link below, you will be taken to a secure PayPal page in order to complete your payment.


Educational Information

At Northern Rehab, educational information is important to us. We enjoy presenting educational seminars to schools, organizations, and businesses in our community. Northern Rehab’s professionals include a wide range of of educational seminars targeted toward athletes of all levels and sports, local coaches, and parents, as well as workers injury prevention and other general discussions. Topics include: proper warm-up, performance enhancement for general sports, running and golf performance enhancement, as well as proper hydration and injury prevention and concussion/ImPACT assessment education for all sports. Additionally, presentations will include injury prevention in the workplace or home, discussion about back pain, neck pain, headaches and TMJ, dizziness, fall prevention and more. We can customize a topic at your request. Contact us at 815.756.8524 to find out what programs we can offer you and your team, business, or organization.

Additionally, you may click on the links below to view various educational information.