Patient Forms

Download and complete these forms before your first visit to help us provide the best care for your child.

📥 New Patients Start Here

📋

New Patient Intake Packet

Required

Complete intake packet with all required forms in one document. Includes patient information, consent, financial policy, HIPAA notice, and Good Faith Estimate.

Download PDF

📄 Individual Forms

Need a specific form? Download individually below.

✅

Consent for Treatment

Authorization for occupational therapy evaluation and treatment services.

Download
💳

Financial Policy & Cancellation Agreement

Payment policy, fee schedule, cancellation policy, and Step Up for Students information.

Download
🔒

HIPAA Notice of Privacy Practices

Information about how we protect and use your health information.

Download
📤

Authorization to Release Information

Permission to share records with schools, doctors, or other providers.

Download
💰

Good Faith Estimate

Estimate of expected costs for services (required by No Surprises Act for self-pay patients).

Download

📝 Ongoing Documentation

Forms used throughout your child's therapy.

✍️

Session Attendance Log

Monthly log for tracking therapy sessions. Parents sign to verify attendance. Required for Step Up for Students scholarship documentation.

Download PDF

📌 Instructions

  • 1.Download the New Patient Intake Packet — it contains all required forms.
  • 2.Complete all sections and sign where indicated.
  • 3.Bring completed forms to your first visit, or arrive 15 minutes early.
  • 4.If using Step Up for Students, have your scholarship ID ready.

Have questions about the forms?

Contact Us