Postural Restoration Center™ Renewal Application

Application Type(Required)

Initial Application

Renewal Application

Business Name(Required)

Contact Person(Required)

First Last

Email(Required)

Phone(Required)

Please list all Postural Restoration Credentialed (PRC or PRT) professionals on-site:(Required)

One per line

Please list all staff (full-time and part-time) who are eligible for PRI Credentialing:(Required)

Please list one per line and included their credentials after their names. Those eligible for PRI credentialing include PT’s, PTA’s, DC’s, OT’s, ATC’s with certification through the BOC, Athletic Therapists with certification through the CATA, CSCS or CSPS with certification through the NSCA, SCCC with certification through the CSCCa, and Exercise Physiologists with certification through the ACSM.

Please list all eligible staff added in the past year (and start date):

Please list the name and credentials of any individual who is eligible for PRI credentialing who has begun working at your clinic or business within the past year (please include their start date next to their name).

Your Company Logo(Required)

Accepted file types: jpg, jpeg, gif, png, pdf, Max. file size: 256 MB.

Company Website

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Postural Restoration Center™ Renewal Application

For Providers

For Patients

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