Washington PT/OT Referral Form is a document used by medical professionals in the state of Washington to refer patients for physical therapy (PT) or occupational therapy (OT). The form is designed to provide detailed information about the patient's condition, referral needs, and contact information for both the referring provider and the patient. It includes sections for the patient's name, date of birth, medical diagnosis, referral needs, and any special instructions. The form also includes spaces for medical providers to provide their signatures, date of referral, and contact information. The Washington PT/OT Referral Form is available in both online and print formats. There are two different versions of the form: one for PT referrals and one for OT referrals.