Email forms to: office@dicptherapy.com
Please fill out the following forms for occupational therapy treatment:
- Registration Form
- Service Agreement for Occupational Therapy Treatment
- Service Agreement for Speech Therapy Treatment
- 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)
- Consent for Photographs/Videos, Acknowledgement of Receipt of Privacy Policies and Practices and Acknowledgement of Receipt of Cancellation Policy
- Emergency Medical/Transportation Release
- Physician Referral for Occupational Therapy (if you plan to submit receipts for insurance reimbursement)
- Release of Information (if there is someone you would like us to contact)