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Northland Community & Technical College

Schedule Appointment

Physical Therapy Clinic

Book your free physical therapy session at our East Grand Forks Campus clinic. Fill out the form below to request an appointment.

New Patient Scheduling Intake Form

This field is for validation purposes and should be left unchanged.

Patient Information

Full Name(Required)
MM slash DD slash YYYY
Sex


PTA Clinic Appointment Text Reminders (Opt‑In)

Address(Required)

Reason for Visit

Please include specific body part, side of body, balance concerns, weakness, etc.

Related Conditions

Is your condition related to a work injury or covered by workers’ compensation?
Is your condition part of an active lawsuit?

Referral Source

Who referred you to our clinic?(Required)