Email forms to: office@dicptherapy.com
Please fill out the following forms for an evaluation or consultation:
- Registration Form
- Service Agreement For Occupational Therapy Evaluation / Consultation
- Service Agreement For Speech Therapy Evaluation / Consultation
- Sensorimotor History(functioning at or above elementary school age level) or Young Child Sensorimotor History (functioning at preschool level) or Developmental History for Infants (functioning at an infant/toddler level)
- Acknowledgement of Receipt of Privacy Policies and Practices
- Physician Referral for Occupational Therapy (if you plan to submit receipts of insurance reimbursement)
- Release of Information (if there is someone you would like us to contact)