Start Therapy Forms

Below you will find the forms Bothell Pediatric and Hand Therapy needs completed prior to the initial evaluation. Please click on the PDF forms, then download, open up, print and complete before you come in. You can also find blank referral forms for your doctor to fill out and send to us. Remember that it is your responsibility to know your insurance coverage 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. Please remember to also bring with you Doctor’s prescription with diagnosis, length of treatment and dated, any previous reports/evaluations/IEPs and your insurance card(s).