850-994-3456 | Locations | Employment
Speech Therapy | Feeding Therapy | Physical Therapy | Occupational Therapy | School-Based Therapy
  Therapy Services  
  School-Based Therapy  
  Parent Resources  
  Getting Started
  Helpful Links
  New Patient Forms
  Social Media
  About Us  
  Our Team
  Contact Us


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.