Intake Forms

Pediatric PT & OT Services - Seattle, WA Pacific NW Pediatric Therapy - Portland, OR

Please complete our Intake Questionnaire, Contract for Services and Authorization to Exchange Information  then print and mail the completed forms to our main office.

• Seattle – 20310 19th Ave NE, Shoreline, WA 98155
• Portland – 4305 SE Milwaukie Ave, Portland, OR 97202

We will notify you by e-mail or phone when the information is received and will do our best to schedule therapy as quickly as we can.

Remember it is important to save the following Word files onto to your computer before you complete them. Please keep the files on your computer until we confirm receipt at our office and we suggest that you also keep a printed copy for your records.

Intake Questionnaire

Contract for Services

Authorization to Exchange Information