Postural Restoration Center™ Renewal Application

Due July 1st of each year.

Today's Date
Business Name
Business Name
Contact Person
Contact Person
Please list all Postural Restoration Credentialed (PRC or PRT) professionals on-site:
Please list all staff (full-time and part-time) who are eligible for PRI Credentialing. Please 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 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).