Kiddotherapy
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Forms

If you have any questions or concerns about any of the forms please contact us.

Media Release

Step 1

Website and Social Media Release Form

COVID-19

Step 1

Covid-19/Coronavirus Exposure Mitigation Agreement 

Client/Parent Agreement

HIPPA

Step 1

This notice describes how medical information about you may be used and disclosed. 

Consent for Release of Medical Information

Step 4

This is to authorize that the information regarding the above individual be forwarded by mail, fax, or phone. 

Intake Form

Step 4

I hereby give my agreement and consent to kiddOTherapy to furnish appropriate rehabilitative care and treatment according to the recommended plan of care as discussed with my therapist.

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P.O. Box 5192 Incline Village, NV 89450 | Phone: (513) 309-3905 | Email: info@kiddotherapy.com