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