Registration Forms
The following is a checklist of information that Bothell Pediatric and Hand Therapy needs prior to the initial evaluation. The listed forms that are links are in PDF format. Please download, open up and print so that they can be completed before you come in. Remember that it is your responsibility to know your insurance coverages including co-payments and how many visits you are authorized. Of course we are willing to help you in figuring out this information any way that we can.
- Doctor's prescription with diagnosis and length of treatment (dated)
- Insurance Card(s)
- Previous reports/evaluations/ IEPs (if any)
- Authorization for Exchange of Information
- Insurance Verification Form
- New Patient Information Form
- Notice of Privacy Practices
- Developmental History Form
- Patient Contract for Services
- Emergency Contact Information
- Animal Therapy Release
- Photo and Video Release