Forms

Kiddotherapy

The following forms will need to be completed as part of the intake process. If you have any questions or concerns about any of the forms please contact us.

Media Release Form

Step 1

Website and Social Media Release Form

Download

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COVID-19 Form

Step 1

Covid-19/Coronavirus Exposure Mitigation Agreement

Download

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HIPPA Form

Step 1

This form explains how confidential information about your child is disclosed.

Download

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Consent for Release of Medical Information Form

Step 4

This form will need to be signed if kiddOTherapy will be collaborating with any other professionals or agencies working with your child.

Download

Sub text

Intake Form

Step 4

This form includes demographic information, insurance, and also kiddOTherapy's cancellation and no show policy.

Forms

Media Release Form

Step 1

COVID-19 Form

Step 1

HIPPA Form

Step 1

Consent for Release of Medical Information Form

Step 4

Intake Form

Step 4

Copyright © kiddOTherapy. All Right Reserved.

P.O. Box 5192 Incline Village, NV 89450 | Phone: (513) 309-3905 | Email: [email protected]