The Pediatric Clinic 425-481-1933 | The Hand Clinic 425-892-2243 [email protected]

Therapy Intake Forms

form icon for filling out therapy intake forms at bothell pediatric and hand therapy

If you’d like to begin Pediatric or Hand therapy with us, please fill out the form below.

We’ll be in contact shortly with next steps. Thank you!

I'm interested in (check all that apply):

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INSURANCE INFORMATION

It is your responsibility to understand your insurance coverage.

As a courtesy, we will contact your insurance company to verify eligibility and determine if prior authorization is needed for treatment.
We highly encourage you to contact your insurance company directly for details of your specific plan’s limitations, exclusions, and benefits.  

For details on insurance, please visit our Insurance Information page >