Please send referral or prescription form from your child's pediatrician that includes the therapy requested, and a diagnosis code to our office (FAX: 772-336-6929)
For Speech and/or Language Therapy and Occupational Therapy, please print and complete our New Patient Case History Form which is located above.
Please provide any previous evaluations or treatment information that your child has received in the past. This is beneficial for our records and in providing consistent therapies.
General Forms to Complete
New Patient Case History Form
Attendance Policy
Consent for Teletherapy Services and Treatment
Financial Policy
Photo Release
HIPPA Form
Release of Information
Insurance
Contact your insurance company to determine if your therapy is covered; if it is, find out your deductible, and any limitations your plan may have.
If your policy requires a referral, make sure to send it to our office prior to your evaluation and/or your child’s first appointment.
Please notify our office immediately of any changes with your insurance company.
