*Enroll your Child*

To help alleviate congestion with packet requests our office has designed this webpage to help you get your child enrolled for an evaluation much more efficiently. 

Please read all introductions and policies as you will be asked to sign in agreement with what is outlined in this page

After you have read the information provided open and print the documents, copy front and back of all insurance cards and send them to our office.  Once all required information has been received your child will be placed on the waiting list.  

Open, Print, Fill Out and Send in these forms along with a copy of your insurance card to complete the enrollment process and have your child placed on the waiting list for an evaluation or to enroll in classes.


Updated Face Sheet and Consent Form.doc

Payment Contract.doc

Signature Page.doc

 Sensory History Questionnaire.do

Do not forget to include:

  • Copies of your insurance cards, front and back
  • All requested forms, completed and signed
  • Alternate phone numbers
  • Current evaluations or clinical documentation

When an evaluation appointment comes available, we will call to set up the time and date. IT IS VERY IMPORTANT THAT YOU LIST ALL PHONE NUMBERS WHERE YOU CAN BE REACHED.  When an evaluation time opens up we try to fill it quickly.  The easier it is to reach you the more quickly we can get your child into an evaluation slot.  We will leave a message if we can not speak you directly, however we may offer a time slot to several people if we can not get a hold of you to confirm your interest and availability. 

Due to the growing numbers of children on our waiting list we are starting anew program that we hope will get more help to families waiting for therapy. Time slots for weekly therapy services do not open up frequently and because of this families have ended up waiting for some time. 

In addition if your child has had an evaluation and you are waiting for a weekly time slot there is a "cancellation list" that allows your child to attend open slots from other children who have cancelled for the day.  Although your child would not have a permanent weekly session scheduled, once the evaluation is completed we would provide home program ideas and put your child on a list to be called whenever there is an opening. When there is a cancellation on a therapist’s schedule you will be called and given an opportunity to come for a problem solving and treatment session adding to the bank of ideas you have for working on issues at home.  You may choose to come at the offered time or not.  If you are not available at the time offered it will not affect your standing on the waiting list in terms of finding you a permanent weekly slot.  When a weekly appointment becomes available you will then be added to the normal schedule.  

Please arrive 10 minutes early at the Administrative Office to fill out any missed paperwork and to make current copies of your insurance card and or coupon. At that time Danielle will also go over the Cancellation, No-Show, Payment and Weather Policies and answer any questions you have. If you have a co-pay or are paying privately payment is due at the time of service. If your child's evaluation is being completed by a therapist other than Susan McNutt you will then be directed to The Annex across the street for your appointment.


*All suggested resources are listed on our Resource Page, if you need any assistance in completing your child's registration feel free to call Danielle during office hours, Monday through Friday, 9am to 3pm.

*If you are needing additional clinical information or resources please utilize the Contact Us form at the bottom of this page and your e-mail will be forwarded to Susan for clinical review and response.

Introduction to our Clinic

Thank you for your interest in seeking services for your child. As you may know, there is a shortage of pediatric therapists in this area. We are expanding and making every effort to meet the needs of this community, however there may be a wait time before you are able to be scheduled for an evaluation and consistent therapy time. Please return the packet of information as quickly as possible so that we can put you on the list for scheduling an evaluation. A written report and explanation of findings with recommendations will follow.

Because we have many families waiting for an evaluation once you commit to a date we ask that you make every effort to keep that appointment. *If you miss one scheduled evaluation due to unforeseen circumstances such as a sick child, we will reschedule you as soon as possible placing your child back at the top of the waiting list. However, if you miss your scheduled evaluation without notifying the clinic we will reschedule you only after you have called the clinic at which time you will be placed back at the bottom of the waiting list.We sincerely apologize for any inconvenience this may cause, however, with so many children waiting for services it is very important to keep your scheduled evaluation time as it has an impact on all the children on the waiting list.

Therapy sessions are scheduled for one hour, starting the transition to leave 5-10 minutes before the hour in order to make for smoother transitions and to give a few minutes for note taking before the next scheduled appointment. It is crucial that therapy sessions be as consistent as possible, although emergencies may arise and this is understandable; please call to cancel 36 hours in advance when possible. If you are finding it difficult to make therapy sessions consistently please discuss possible solutions with your therapist. If therapy sessions are missed consistently we will be unable to help your child and will need to utilize your time slot so that other children can be served.

Prior to the first session, it is your responsibility to obtain authorization from your insurance company and a prescription or referral from your PCP depending on the requirements of your personal insurance plan. We bill your insurance company directly so we will need a copy of your insurance card or medical coupon; however any unpaid balances are ultimately your responsibility. It is important to have authorization for exchange of information with various health professionals and with your insurance company. Please read over the privacy policy and let us know if there are any questions or concerns.

Notice of Privacy Practices

As required by the privacy regulations created as a result of the Health Insurance Portability and Accountability Act of 1996 (HIPAA)

This notice describes how health information about you or your child may be used and disclosed and how you can get access to you "individually identifiable health information". Please review this notice carefully.

In providing therapy services to your child, records will be kept regarding the treatment and services that are provided. I am required by law to provide you with this notice of legal duties and the privacy practices that are maintained in this practice concerning your "IIHI". A copy of the current notice of privacy will be posted in the office and you may request a copy at any time. Your IIHA may be used or disclosed in the following ways:

1. Treatment: Information you provide and records kept will be used to assist in the treatment of your child. Information may be shared with family members, respite or assistant care takers when appropriate for the treatment and care of your child.

2. Payment: Information may be used and disclosed to your insurance company in order to bill and collect payment for the services that you receive. Your health insurance may be contacted to determine extent of benefits and details regarding treatment may be disclosed in order to determine if insurance benefits will cover therapy services. Information may also be used and disclosed to obtain payment from third parties that may be responsible for payment.

3. Appointment Reminders: Information may be used in order to contact you and remind you of an appointment.

4. Treatment Options: Information may be used and disclosed in order to inform you of additional options or alternatives for treatment or services.

5. Release of Information to Family/Friends/Care Providers: Information may be released to a family member, friend or care provider who is involved in your child's care.

6. Disclosures required by law: Information may be used and disclosed when it is required by federal, state or local law .


a. Information may be disclosed to public health authorities that are authorized by law to collect; information for purposes such as

i. reporting child abuse or neglect

ii. preventing or controlling disease, injury or disability

iii. notifying a person regarding potential exposure to a communicable disease or condition

iv. reporting reactions to drugs or problems with products

b. Information may be disclosed to a health oversight agency for activities authorized by law. Oversight activities can include for example: investigations, inspections, audits, licencure and disciplinary actions: civil, administrative, and criminal procedures or other activities necessary for the government to monitor government programs, compliance with civil rights laws and the health care system in general.

c. Lawsuits and Similar proceedings; or in response to a discovery request, subpoena, or other lawful process by another party involved in the dispute but only if you have been informed of the requested.

d. Law enforcement: Information may be released if asked to do so by a law enforcement official in response to a warrant, summons, court order, subpoena, or similar legal process.

Your rights regarding your IIHI:

1. Confidential communications: you have the right to request that information be communicated in a particular manner or location, for example you may ask to be contacted at home rather than at work. You do not need to give reason for your request.

2. Requesting restrictions: you have the right to request restrictions to use or disclose your information only to certain individuals involved in the care of your child or in the payment of services.

3. Inspection and copies: you have the right to obtain and inspect your child’s records, reports and notes.

4. Amendments: you may ask to have records amended if you believe they are incorrect or incomplete.

5. Right to a paper copy of this notice you are entitled to receive a paper copy of this notice of privacy practices. You may ask for a copy of this notice at any time.

6. Right to file a complaint: if you believe your privacy rights have been violated, you may file a complaint and will not be penalized for filing this complaint.

7. Right to provide an authorization for other uses and disclosures: your written authorization will be obtained for uses and disclosures that are not identified by this notice or permitted by applicable law. Any authorization that you provide may also be revoked by you at any time in writing. After you revoke your authorization your information will no longer be used for the proposes described in that authorization.

Payment Policy

It is our policy to try to make payments and co-payments affordable for families and we are very willing to work with you. It is ultimately your responsibility to cover payment for services if your insurance company does not cover a service, so please familiarize yourself with your child’s benefits. If you are unable however, to make a payment or co-payment as determined by your policy, please call the office as soon as you are able and make arrangements for a payment plan and subsequent co-pay amounts that will suit your family’s needs.

As a parent or caregiver the detailed benefits, co-pay amounts, deductible amounts, visit limits, authorization expiration dates, etc. are very important for you to know and communicate to our office prior to therapy. You are responsible for notifying the office when a change in insurance coverage occurs or when new cards are issued. If there is a lapse in coverage any and all charges not covered will be billed to you. All charges not covered by insurance for any reason will be your responsibility. This includes Medicaid when an open coupon is changed to an HMO, the HMO itself is changed, and Medicaid becomes secondary or is dropped altogether.

Co-Pays and Private Pay Rates are to be paid on the day of service before or during treatment to the Office Manager at the Administrative Office. If your child is being treated at The Annex you may also dispense payment into the lock box as it will be collected the next day. Failure to pay at the time of service will result in a $2.00 finance charge per date of service. Any balances over $500 or delinquent for no more than 3 months will result in interruption of services.

Benefits, Referral, Prescription or Prior Approval

Download the Payment Contractand fill out the form by calling your private insurance company to determine if you have outpatient occupational or physical therapy coverage. It is ultimately your responsibility to cover payment for services if your insurance company does not pay.

Call the 800 number listed on the back of your insurance card. Talk with a representative; do not use an automated system. keep a record of all communications with your insurance company. If your child is younger than seven years old find out about neurodevelopmental outpatient occupational therapy services coverage or the extent of outpatient occupational therapy service coverage ( DO NOT ask for benefits on a specific modality such as sensory integration or therapeutic riding). If your child is at least seven years old ask about outpatient occupational therapy services and the criteria for receiving benefits or coverage. (Again, do not ask for benefits on a specific modality such as sensory integration or therapeutic riding).

Any insurance company (except Medicaid open coupon) may require one or more of the following before paying for services, please find out and have these available prior to the evaluation. They can be faxed to 360-398-2772 or mailed to our home office.

Referral or prescription should read: "Occupational or Physical Therapy evaluation and treatment as necessary. Prior Approval the Physician will need to include:

1. Pediatric NDT & SI Therapy Services as the place of service or provider.

2. Occupational or Physical Therapy evaluation and treatment as necessary

3. CPT Code: 97530 Therapeutic Activities

4. ICD10 Code: determined by the physician but these are some of the ones insurances will accept

  a. Lack of normal physiological development

  b. Developmental Coordination Delay

  c. Developmental Delay

  d. Static Encephalopathy

  e. Dyspraxia

   f. Hypotonia

Cancellation Policy

Any child missing more than 5 therapy sessions during a 12 week period will be discontinued active therapy and placed back on the waiting list per therapists discretion. If the child's therapy is scheduled every other week he or she may not miss more than 3 sessions in a 12 week period due to the length of time between treatments. Consistent treatment is crucial to progress and positive outcomes.

No Show Policy

We require 24 hour notice of cancellation for the missed appointment to not be counted as a "No-Show". However, sickness, car trouble, etc. is spontaneous and unexpected. A No-Show appointment is determined by the therapist.

The first No-Show will receive a warning and a $40 charge issued during the next scheduled appointment and is to be paid to the treating therapist at the following scheduled appointment or before services are continued.

The second No-Show will result in discontinuation of active therapy and a $40 charge to be paid to the treating therapist.

Weather Policy

In the event of extreme weather if you are not comfortable with driving conditions you will call and cancel your appointment. A twenty-four hour notice is absolutely not necessary when driving conditions are questionable. You may call the clinic or check the website under Just for Parents for driving and weather conditions.

Cancelled appointments due to driving conditions are exempt from the cancellation policy, however, they are still subject to the No Show Policy if no communication has been attempted. If a person is not reached at the office you must leave a message to avoid being counted as a No Show.

Pediatric NDT & SI Therapy Services

Susan McNutt, OTR/L

348 W. King Tut Road

Bellingham WA 98226

Phone: 360-398-2772
Fax: 360-398-2772


Danielle Snapp, Office Manager


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