Patient Forms
To save time at your first visit, download and complete the following forms ahead of time, and we’ll get you started even faster.

We'll Verify Your Insurance!
Northern Arizona Physical Therapy Associates accepts virtually all major insurance carriers and participates with many local provider networks. Our friendly staff can verify insurance for you or call (928) 440 - 6880.

Phone:  (928) 440 - 6880
Fax:  (928) 529 - 5036

Referring Provider Forms
Would you like to send us one of your patients?  Feel free to use your own referral/prescription or we have created one for you to streamline the process.   

Medical Records
To request patient records, please download and complete this form. Email the completed form, and the specific information needed for the request, to our Medical Records Department at Requests and forms can also be faxed to (928) 529 - 5036.

  • Authorization for Access, Use and/or Disclosure of Protected Health Information

Main Office

2404 Stockton Hill Road, Suite K

Kingman, Arizona 86401