New Patient Intake

Welcome to IPT Miami!

We are happy to have you as a new patient! Please complete the form below and be sure to include a picture of your insurance information, your drivers license and any prescriptions you are currently taking.

New Patient Intake Form

New Patient Information:

First Name:*

Last Name:*

Date of Birth:*

Email:*

Address:*

City:*

State:*

Zipcode:*

Emergency Contact Information:

First Name:

Last Name:

Phone Number:

Relationship to Patient:

IPT Office Location

IPT Office Location:*

North Miami, FL Hallandale Beach, FL Wynwood, FL

Reason for Visit (Condition)

Comments / Notes:

Upload Documents Field (Insurance Card, Drivers License, Prescriptions):

North Miami

2142 NE 123rd Street
North Miami, FL 33181
Hallandale

1000 South Dixie Highway,
Hallandale Beach, FL 33009
Wynwood

1850 NW 7th Avenue
Miami FL 33136
Call Now

305.967.8976 - North Miami

954.458.5700 - Hallandale

305.967.8976 - Wynwood

(Option 2)
FAX NOW

305.967.8863 - North Miami

954.458.5110 - Hallandale

305.967.8863 - Wynwood

INTEGRATED PHYSICAL THERAPY & WELLNESS

Experience the care at Integrated Physical Therapy & Wellness, where your mobility, strength, and well-being are our focus. Our skilled therapists use advanced techniques and personalized care to treat sports injuries, orthopedic rehabilitation, post-surgical recovery, and chronic pain. Located in North Miami, Hallandale and Wynwood, our facilities and compassionate team provide a supportive environment for your recovery journey. Whether you're an athlete or recovering from surgery, we are here to guide you every step of the way. Take charge of your health and schedule an appointment with us today at 305-967-8976!