Enroll your Child

To enroll your child for an evaluation, please read carefully through our Clinic Introduction and Policies before you sign your paperwork. Next, fill out the documents below. You can either complete them online and email them to our office, or print them and deliver or mail physical copies to our office.

Once we receive all your required information, your child will be placed on the waiting list.

Do not forget to include:

Your child’s Referral
Copies of your insurance cards, front and back
All requested forms, completed and signed
Alternate phone numbers
Current evaluations or clinical documentation, if applicable

If you need help completing your child's registration, feel free to email Jenn. You can also call during office hours, Monday through Friday, 9am to 3pm.

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 scheduled. We will leave a message if we can not speak you directly; however, we may offer a time slot to several people if we cannot reach you to confirm your interest and availability.

For your initial evaluation, please arrive 10 minutes early and come into the Administrative Office to fill out any missed paperwork and to make current copies of your insurance card. At that time Jenn 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 time of service.

Please refer to our Resources page for helpful links and relevant information.

Benefits, Referral, Prescription or Prior Approval

It is ultimately your responsibility to cover payment for services if your insurance company does not pay.

To determine if you have outpatient occupational or physical therapy coverage, download the Payment Contract document and call your private insurance company for the information you need to fill out this form. 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.

Your child’s 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

Enroll Your Child

Enroll your Child

Face Sheet & Release Form

Payment Contract

Signature Page

Sensory Questionnaire

Consent Form

Once we receive all your required information, your child will be placed on the waiting list.

Do not forget to include:

Your child’s Referral

Copies of your insurance cards, front and back

All requested forms, completed and signed

Alternate phone numbers

Current evaluations or clinical documentation, if applicable

If you need help completing your child's registration, feel free to email Jenn. You can also call during office hours, Monday through Friday, 9am to 3pm.

Please refer to our Resources page for helpful links and relevant information.

Benefits, Referral, Prescription or Prior Approval

It is ultimately your responsibility to cover payment for services if your insurance company does not pay.

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.

Your child’s 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