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

Therapy Intake Forms

To serve our patients better, we now have our intake forms online.

PEDIATRIC THERAPY FORMS

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

Before scheduling, please fill out the PEDIATRIC THERAPY INTAKE FORM below.

If you do not already have a referral from your pediatrician, please have your child’s doctor fill out the referral form.
After your intake forms are submitted and processed, you will be sent a secondary set of forms specific to the type of therapy your child will receive.

Thank you, we look forward to serving you.

HAND THERAPY FORMS

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

Hand patients, please fill out the HAND THERAPY INTAKE FORM below.

If you do not already have a referral from your doctor, please have your doctor fill out the referral form.

Thank you, we look forward to serving you.

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 >