Forms & First Visit Info
Please bring the following with you for your child’s initial appointment.
- Insurance Card
- Driver’s License
- Previous reports/evaluations/IEPs (if you haven’t already sent them in with your paperwork)
The following forms are part of our patient registration process and are available here for your convenience. The first 8 forms listed are necessary for all patients to complete. Our staff will let you know if you need to fill out any of the additional forms listed. The forms are in PDF format and you can download, open, and print so you can complete them and return them 3-4 days prior to your appointment via Email to email@example.com or Fax to 770-783-5049.
Our office would also be happy to send you these forms via US mail or email if you are not able to download them.
- In Harmony Pediatric Therapy Welcome Letter
- 2015 New Patient Paperwork
- Sensorimotor History (to be completed by all Occupational Therapy clients)
- Speech Questionnaire (to be completed by all Speech-Language Therapy clients)
- Feeding Questionnaire (to be completed by all Feeding Therapy clients)
Included in the New Patient Paperwork you will find:
- New Patient Information Form
- Financial & Insurance Policy
- Permission for Exchange of Medical Information
- Permission for family to leave site during treatment
- Consent for Audio/Visual Release
- Consent for Photographic Release
- Attendance Policy
- Acknowledgement of Receipt of Notice of Privacy Practices and Consent/Limited Authorization & Release Form