New Patient Forms
We're glad you're here. Completing your child's paperwork before the first visit means more time for therapy and less time in the waiting room.
- 1Your provider faxes the referralYour child's pediatrician, family practitioner or primary care provider faxes it to (800) 420-3359.
- 2We call youWe verify your benefits and schedule your child's evaluation.
- 3Complete your formsFill them out online in about 15–20 minutes, or download and print them and bring them to your first visit.
Fill out your forms online
Complete and sign every form right on your phone or computer, step by step. No printing or scanning. Your answers are sent securely to our clinic team.
Prefer paper? Download the packet
One PDF with every form. You can type right into it on a computer or phone, or print it. Please sign and date each form on its own line.
Or download one form at a time
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1. New Patient Intake & Child HistoryAll familiesDownload PDF for form 1
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2. HIPAA Privacy Acknowledgment & Communication PreferencesAll familiesDownload PDF for form 2
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3. Consent to Evaluate and Treat: Occupational TherapyChildren receiving OT (complete Forms 3 and 4 if your child gets both)Download PDF for form 3
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4. Consent to Evaluate and Treat: Speech TherapyChildren receiving speech (complete Forms 3 and 4 if your child gets both)Download PDF for form 4
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5. Professional Relationship with Your Child’s TherapistsAll familiesDownload PDF for form 5
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6. Client & Family Rights AcknowledgmentAll familiesDownload PDF for form 6
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7. Attendance & Cancellation PolicyAll familiesDownload PDF for form 7
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8. Financial Policy & Card-on-File AuthorizationCommercial insurance only. Never write a card number on a formDownload PDF for form 8
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9. Authorization to Exchange InformationAll families: who may pick up your child or receive informationDownload PDF for form 9
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10. Photo & Video ReleaseOptionalDownload PDF for form 10
About payment
TennCare and TEIS families: you have no out-of-pocket costs for covered therapy services, and we will never ask you for a card or charge you a fee.
Commercial insurance families: copays are due at the time of service. We'll walk you through our financial policy and how to keep a card on file when we call to schedule. Please never write a card number on a paper form or send it through this website.
Send us documents securely
Use this secure upload to send photos of your child's insurance card (front and back), completed intake forms, or past evaluations, IEPs or IFSPs. Files go straight to our clinic team, who add them to your child's file. Please don't email these documents.