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PREPARE FOR YOUR VISIT

Patient Forms

Forms for both new and returning patients. 

PREPARE FOR YOUR VISIT

Online forms using IntakeQ

Completing your registration forms online streamlines our intake process and saves time over filling out traditional forms on a clipboard. IntakeQ is a secure, HIPAA-compliant electronic intake platform. Simply click on the links below as directed by your provider or RIW coordinator and follow the instructions.

New patient registration forms

New Patient Registration

Telehealth Consent Form (English

Telehealth Consent (En Espanol)

Notice of Privacy Practices

Brain Injury Rehabilitation Program

Intake History

New Patient Registration

Discharge Questionnaire

Consent to Participate in Treatment

Structured Intensive Multidisciplinary Program

Intake History

Intake Questionnaire

Consent to Participate in Treatment

Workers' Compensation Forms

Travel Reimbursement Request

Activity Prescription Form (APF)

Preferred Worker Program Brochure

En Espanol

Practicas Privadas

Solicitud para el reembolso de gastos de viaje

Programa con incentivos para reemplear trabajadores lesionados

CONTACT US

Visit our facility next to Seattle Center in Lower Queen Anne. We have parking on site and are located near several bus lines.

415 1st Avenue N, Suite 200, Seattle, WA 98109

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