Patient Resources

If you are a new patient, you can print the necessary forms below. If you would like to make a payment, click here to skip to the payment form.

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.

Your Rights Against Surprise Medical Bills

The No Surprise Act, which offers protection against surprise medical bills from an out-of-network provider, took effect January 1, 2022. If you choose to self-pay for care, this Act ensures your right to receive a good faith estimate of how much your care will cost before you receive it. In an effort to comply with this Act, Northern Rehab Physical Therapy Specialists will provide a cost estimate for your physical therapy examination and subsequent treatment sessions prior to starting care.

Contact Northern Rehab at 815.756.8524 for questions or more information.

For more information about your rights under Illinois General Assembly Public Act 096-1523 please visit www.cms.gov/nosurprises.


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 your 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.