NEW PATIENTS

Forms & Policies

Rocket

FORMS

Please find the form you need below, download it, fill it out, and email back to us at: info@blastofftherapy.com

Welcome Letter

Speech Therapy Pediatric Case History

Occupational Therapy Pediatric Case History

Physical Therapy Pediatric Case History

Clinical Services Agreement

Consent To Release

Waiver of Liability

Notice of Privacy Practices

Permission to Reproduce Audio and Video

Insurance Form

COVID-19 Protocols and Procedures

Medical Updates Form

 Credit Card Preauthorization

Teletherapy Consent

RESOURCES

New Patient Information

Request an Evaluation

Hours & Location