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.

All BPHT Services:

1. Doctor’s prescription with diagnosis and length of treatment (dated)
2. Previous reports/evaluations/ IEPs (if any)
3. Insurance Card(s)
4. Insurance Benefit Verification Form

BPHT Pediatric Therapy Services:

1. Pediatric Therapy Registration Forms
2. Pool Therapy Forms
3. Feeding Therapy Forms

BPHT Hand Therapy Services:

1. Hand Therapy Registration Forms