After your appointment is confirmed, you will receive three separate emails from contact@roamptnorthwest.com with the subject line “ROAM Physical Therapy”.

These emails include:

• Your Patient Intake Form

• Your PROM (Patient-Reported Outcome Measures) survey

• A confirmation of your scheduled appointment

Why completing these forms matters

Taking a few minutes to fill them out in full before your visit allows Louis to walk into your home fully prepared. He’ll already understand your health history, symptoms, and goals — so your entire first appointment can be dedicated to hands-on evaluation, personalized treatment, and getting you on the path to feeling and moving better as quickly as possible.

Please complete your Patient Intake Form and PROM survey in their entirety prior to your scheduled initial evaluation.

Please see below for step-by-step instructions on completing your digital Intake Form.

Click the blue button labeled “Intake Form Link” in email titled “Please Complete Your Intake Form Before Your Appointment”

Note: For your initial evaluation, the PROM questions are included inside the Intake Form. You do not need to click the separate “Complete PROM” button in the other email.

2) A 6-digit verification code will be sent to your email. Enter the code and click continue.

Completing Your Intake Form

(takes ~10–15 minutes)

1. Open the Intake Form email and click the blue button labeled “Intake Form Link”.
   
   

2. Enter your email address. You’ll receive a 6-digit verification code by email — enter it to log in.
   
   

3. On the “Upcoming Appointments” screen, tap the big blue “Fill Intake” button.
   
   

You will then complete several short sections (you can see your progress at the top with checkmarks):

• Personal Details — Basic information, address, phone numbers (with Home/Work/Cell labels), and emergency contact information.

• Consent Forms — Review and sign our consent documents. You will also select your payment election: In-Network Insurance, Out-of-Network Insurance, or Self-Pay.
  

• Medical Details — Please take a moment to thoroughly complete this section. Include your height, weight, current medical conditions, symptoms you’re experiencing, medications, allergies, surgical history, family health history, exercise habits, recent falls, and smoking status. This information is very important — it helps us understand your full health picture, ensure your safety, and create the most accurate and effective treatment plan for you.
  

• Insurance Details — If you are using insurance, upload clear photos of the front and back of your insurance card(s), including any supplemental or secondary plans. Self-pay patients can skip this step. This step is essential for insurance patients — it allows us to verify your benefits, coverage, deductible, and any co-pays before your visit.
  

• Physician / Provider Information — Please include your referring physician’s name, phone number, and any referral note if you have one. Washington and Idaho are direct-access states, so most insurance plans do not require a referral — however, providing one (if you have it) helps us streamline the process and coordinate your care more efficiently.
  

• Patient-Reported Outcome Measures — Completing these surveys help us understand how your condition is affecting your daily life and quality of life, so we can tailor your treatment plan to your specific needs and accurately track your progress over time (you can fill this out here this out here or via the PROM email link)

• Reason for Visit — Please describe your main concerns in as much detail as possible. Include the location of your symptoms, how long they have been present, the nature of the symptoms (e.g., pain, stiffness, weakness, numbness), whether this is an acute (new) or chronic (ongoing) issue, and any aggravating or alleviating factors (what makes it better or worse). This helps us build a clear clinical picture before you arrive so we can make the most of your first visit.
  

• Documents — If available, please upload any relevant doctor’s visit notes, imaging reports (X-rays, MRIs, etc.), or insurance authorization notes related to your condition. These help us provide the best possible care right from the start.

How to Complete Your PROM Survey

1. Open the second email you will receive from contact@roamptnorthwest.com which will be titled “Complete Your P.R.O.M. Questionnaire”

2. Click the blue button labeled “Complete PROM”.

3. Answer the short questions about your symptoms and daily function (usually takes just 3–5 minutes).

Why these forms matter

Completing them ahead of time gives Louis a clear picture of your condition and how it affects your daily life as well as track your progress.

For Future PROM Surveys
You may receive additional PROM emails in the future as part of your ongoing care. We kindly ask that you complete them when they arrive. These short surveys help us track your progress, measure improvements, and fine-tune your treatment plan to ensure you’re getting the best possible results.

Please note: Both the Intake Form and PROM survey must be completed before your scheduled initial evaluation. All information is secure and HIPAA-compliant.

Need help?

Reply directly to either email or call/text us at (208) 623-8081. We’re happy to walk you through it step by step.

We look forward to seeing you soon!

4) Briefly describe why you are seeking physical therapy services detailing your symptoms, injury, limitations, weakness, recent surgery, dizziness, etc..)

5) You will then enter your name, email and phone number and click “Create”

6) A 6-digit verification code will be sent to your email. Enter the code and click continue.

7) Your appointment request will be sent but YOU ARE NOT DONE YET. Please click on the “Back to Home” button where you will add your Home Address and Insurance Information (*if applicable)

8) This will take you to your patient portal screen.

• Click on Personal to fill out your Address and all other items with a red asterisk.

• Click on Insurance Card Info and upload your Insurance Card information (Primary and secondary* if applicable) manually or by taking a pictures of the FRONT & BACK of the card

9) The both boxes will turn green when completed.
(Self-pay patients may skip the insurance step)

What Happens Next

Once you have submitted your appointment request and completed your Personal Details (including your home address) and Insurance Information (if applicable), Louis Cerenzia, PT, DPT will contact you within 1 business day.

During the call, he will verify your insurance benefits (including your deductible and any applicable co-pays), review your location, and work with you to schedule your initial evaluation. If you are choosing self-pay, he will also email you a Good Faith Estimate.

Once an appointment time is confirmed, you will receive an email with your Patient Intake Form and PROM (Patient-Reported Outcome Measures) forms. These are required to be completed prior to your scheduled initial evaluation.

For step-by-step instructions, please see our How to Complete Your Intake Forms page.

Important Note:

Submitting your appointment request does not guarantee your exact preferred date and time. As a mobile physical therapy provider serving a large geographic area across Pend Oreille and Bonner Counties, availability can be limited due to high patient demand.

When Louis calls, he will offer several possible dates and times as close as possible to your requested slot. He will work closely with you to find the earliest appointment that best fits your schedule so you can begin treatment as soon as possible.

Need help?

Contact Louis Cerenzia via call or text message at our secure HIPPA compliant line (208) 623-8081.

We’re excited to partner with you on your recovery and help you get back to the activities you love.

Thank you for choosing ROAM Physical Therapy.

1) Click “Book”

1) Click “Book”

1) Click “Book”

1) Click “Book”

Submit the request. You will see a confirmation screen stating “Appointment Request Submitted.”

Step 2: Return to the Patient Portal
Click “Back to Home” to return to your patient portal dashboard.

Step 3: Complete Your Personal Details (Required)
Click the Personal box (it will show as red/incomplete).

• Enter your full home address (this is very important for mobile outpatient services)
  
  

• Add your primary contact phone number and any additional numbers
  
  

• Provide emergency contact information
  
  

Once all required fields are completed, click Save and Continue.
The Personal box will turn green when finished.

Step 4: Add Insurance Information (If using insurance)
If you plan to use your insurance benefits (in-network or out-of-network with a superbill), click the Insurance Card Info box (red/incomplete).

• Upload clear photos of the front and back of your primary (and secondary, if applicable) insurance card, or
  
  

• Enter your insurance details manually
  
  
  The both boxes will turn green when completed.
  (Self-pay patients may skip the insurance step)

What Happens Next
Once you have submitted your appointment request and completed both your Personal Details (including your home address) and Insurance Information (if applicable), Louis Cerenzia, PT, DPT will contact you within 1 business day.

During the call, he will:

• Verify your insurance benefits (if using insurance)
  
  

• Review your location within our large service area (Pend Oreille and Bonner Counties)
  
  

• Schedule your mobile visit at a date and time as close as possible to your requested slot
  
  

Important Note:
Submitting your appointment request does not guarantee your exact preferred date and time. As a mobile physical therapy provider serving a large geographic area across Pend Oreille and Bonner Counties, our availability can be limited due to high patient demand.

When Louis Cerenzia, PT, DPT calls you within one business day, he will review your location and offer several possible dates and times for your initial evaluation as soon as possible to your requested booking time. He will work with you to find the earliest appointment that fits both your schedule and his so you can begin your treatment promptly.

How to Complete Your Online Intake Form (Before Your First Visit)

After we call or text to confirm your appointment date and time, you will receive an email from contact@roamptnorthwest.com with the subject line “ROAM Physical Therapy”.

Here’s what to do (takes about 10–15 minutes):

1. Open the email and click the blue button labeled “Intake Form Link”.
   
   

2. Enter your email address. You’ll receive a 6-digit verification code by email — enter it to log in.
   
   

3. On the “Upcoming Appointments” screen, tap the big blue “Fill Intake” button.
   
   

You will then complete several short sections (you can see your progress at the top with checkmarks):

• Personal Details — Basic information, address, phone numbers (with Home/Work/Cell labels), and emergency contact information.
  
  

• Case Details
  
  

• Consent Forms — Review and sign our consent documents. You will also select your payment election: In-Network Insurance, Out-of-Network Insurance, or Self-Pay.
  
  

• Medical Details — Please take a moment to thoroughly complete this section. Include your height, weight, current medical conditions, symptoms you’re experiencing, medications, allergies, surgical history, family health history, exercise habits, recent falls, and smoking status. This information is very important — it helps us understand your full health picture, ensure your safety, and create the most accurate and effective treatment plan for you.
  
  

• Insurance Details — If you are using insurance, upload clear photos of the front and back of your insurance card(s), including any supplemental or secondary plans. Self-pay patients can skip this step. This step is essential for insurance patients — it allows us to verify your benefits, coverage, deductible, and any co-pays before your visit.
  
  

• Physician / Provider Information — Please include your referring physician’s name, phone number, and any referral note if you have one. Washington and Idaho are direct-access states, so most insurance plans do not require a referral — however, providing one (if you have it) helps us streamline the process and coordinate your care more efficiently.
  
  

• Outcome Measures — Short questions about your symptoms and daily function.
  
  

• Reason for Visit — Please describe your main concerns in as much detail as possible. Include the location of your symptoms, how long they have been present, the nature of the symptoms (e.g., pain, stiffness, weakness, numbness), whether this is an acute (new) or chronic (ongoing) issue, and any aggravating or alleviating factors (what makes it better or worse). This helps us build a clear clinical picture before you arrive so we can make the most of your first visit.
  
  

• Documents — If available, please upload any relevant doctor’s visit notes, imaging reports (X-rays, MRIs, etc.), or insurance authorization notes related to your condition. These help us provide the best possible care right from the start.
  
  

You can save your progress and return later if needed.

You will also receive a separate email asking you to complete the Patient-Reported Outcome Measures (PROM) survey. Simply click the blue “Complete PROM” button in that email — it takes only a few minutes. Completing this survey helps us understand how your condition is affecting your daily life and quality of life, so we can tailor your treatment plan to your specific needs and accurately track your progress over time.

Payment Method on File (Optional but Convenient)
During the process you will have the option to save a secure payment method on file (credit/debit card, HSA/FSA, or ACH/bank transfer). This makes future payments seamless and hands-free at the end of each visit. Important: Your saved payment method will only be used to collect the exact amount you are responsible for after each visit — such as copays, deductibles, self-pay rates shown on your Good Faith Estimate, or any applicable fees according to our Financial & Payment Policy. For out-of-network patients this covers the full amount due at the time of service (you will receive a superbill to submit to your insurance for possible reimbursement). You will always receive a receipt for any charge processed.

Why completing these forms ahead of time is so helpful
Your answers and uploaded documents give us a complete picture of your health history, current symptoms, and daily function before you arrive. This allows us to create a truly personalized treatment plan, ensure your safety, and make the very best use of your first visit together.

Please note: Completing your full intake form — including all consent forms and (if using insurance) uploading your insurance card(s) — is required prior to your initial evaluation. This allows us to verify your benefits ahead of time and ensures your first visit is as smooth and productive as possible.

All information is secure and fully HIPAA-compliant.

Need help?
Simply contact us at contact@roamptnorthwest.com or call/text us at our HIPPA compliant line (208) 623-8081. We’re happy to walk you through the process step by step.

We look forward to meeting you and supporting your recovery!

Thank you for choosing ROAM Physical Therapy.

Our Scheduling Approach

After your initial evaluation, Louis will discuss the recommended plan of care and visit frequency. He will do his best to schedule follow-up visits at days and times that work well for you. However, because we serve a vast area across Pend Oreille and Bonner Counties using a “Smart Cluster System” that groups visits by location to maximize efficiency and access, the specific days and times may vary from week to week.

In rare circumstances, we may request a change to a scheduled visit with at least 24 hours’ notice, and in very rare circumstances the night prior (typically for minor adjustments to the exact time of day to better fit the schedule). We kindly ask that you also provide as much notice as possible when requesting a reschedule—ideally at least 24 hours in advance, or the night prior in extenuating circumstances—so we can best accommodate everyone. We appreciate your understanding and flexibility; Louis will always work with you to minimize disruption and provide seamless, convenient care. We also understand that life happens and will offer the same flexibility when you need to reschedule.

We’re committed to balancing high-quality mobile care with mutual flexibility so more patients in our region can receive timely treatment.

Select ROAM