Intake Form

» Intake Form :

FYZICAL Therapy & Balance Centers Northshore, providing physical therapy, occupational therapy, and specialized balance services in Ozaukee County and surrounding areas north of Milwaukee, offers these online forms for your convenience. By printing them and filling them out prior to your first appointment, you can save time on your arrival at either of our two clinics.

Consent for the purposes of Treatment, Payment and Healthcare Operations
This consent form is a standard disclosure form. Please read and sign.

New Patient Intake Form
This two-page form can be printed, completed and brought with you.

Medical History Questionaire
This form will help us identify where you are feeling pain and will help us customize our meeting with you.