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Getting Started | Evaluation | Scheduling Therapy | New Patient Forms
 
  New Patient Forms  
     
 

The entire staff at Pediatric Therapy Center would like to thank you for choosing us and welcome you to our family. Please complete this form and bring it with you to your first appointment.

Patient Information Form
Click here to download
 

Included in our paperwork you will find:

     
  Consent to treat/medical release
     
  Office policies
     

Please read all pages thoroughly so that you are informed about the agreements you are signing, and ask any questions to better help us serve you and your family.

In addition to our forms, a few other pieces of information will be needed:

     
  Copy of the front and back of your insurance card and/or Medicaid card
     
  Current prescription from PCP (must state ST/OT/PT services)
     
  Most recent ST/OT/PT evaluation and plan of care within the past year (if applicable)
     
  Individual Education Plan (IEP) from the school system (if applicable)
     

We look forward to working with your family. Please refer to the ASHA website for information on private health plans and therapy coverage.

http://www.asha.org/public/coverage/