											Request an Appointment

PHYSICAL THERAPY:

Information for Patients
— What is Physical Therapy?
— What Makes us Different
— Information on Injuries
— Patient Forms
— Request an Appointment

Information for Physicians

Information on Insurance

Services
— Rehab
— Orthotics / Gait
— Metabolic Testing
— Work Conditioning

Evaluation Services:
— Physical Capacity
— Athletic Performance

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Success Stories

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Request an Appointment

* First Name:

* Last:

*Address:

* City:

* State:

* Zip:

* Phone:

* Email:

* under 18?

Yes

If you answered yes, a parent or guardian needs to attend your appointment.

* Nature of injury & Name of Referring Provider:

* Employer:

* Referred by:

* Insurance Company:

* Phone:

Group Number:

* What services are you interested in? Mark all that apply.
	Physical Therapy	Nutrition Counseling
	Metabolic Testing	Weight Loss
	Performance Evaluations	Work Conditioning
	Golf Conditioning

Pre-authorization Form

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Sports Reaction Center
1750 112th Ave NE Suite D-154, Bellevue, Washington 98004 (425) 643-9778
Billing and Insurance Contact Numbers: (206) 542-7118 or (888) 637-0702
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Last Updated : 01/07/2008