Patient Forms
Forms to get started.
Please download, print and complete these forms before your child’s first appointment. It gives your therapist a head start on getting to know your child, and means more time for what matters at your first visit.
Required new-patient forms
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01
Download PDF: Case History Form
Case History Form
Your child’s background, including their complete medical and developmental history. This helps your therapist understand the whole picture before you meet.
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02
Download PDF: Consent for Services
Consent for Services
Explains important Therapy Connections policies and gives our team permission to evaluate and treat your child.
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03
Download PDF: Cancellation & No-Show Policy
Cancellation & No-Show Policy
Our policy for missed, late and cancelled appointments, so you know what to expect when life happens.
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04
Download PDF: Arbitration Agreement
Arbitration Agreement
Describes how any disputes between Therapy Connections, LLC and a patient or their parents or legal guardians will be handled.
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05
Download PDF: Release of Information
Release of Information
Lets us request and share the medical records, testing and other information needed to care for your child.
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06
Download PDF: Insurance Information
Insurance Information
A complete list of your insurance coverage so we can handle billing correctly.
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07
Download PDF: Orthopedic Therapy Form
Orthopedic Therapy Form Orthopedic cases only
For orthopedic cases only: the medical history that matters most for your child’s physical therapy.
Specialty forms
Only complete these if your therapist asks you to.
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08
Download PDF: Therapeutic Listening Follow-Up
Therapeutic Listening Follow-Up
Share how your child responded to our Therapeutic Listening® program. Only needed if your therapist asks you to complete it.
We’re here to help
Let’s help your child take the next step.
Whether you have a specific concern or simply a feeling that something isn’t quite right, we’re here to listen. Give us a call. We’ll talk through what you’re noticing and help you find the right place to start.
