​​Print and bring to medical appointment
 

1. Doctor Referral Form​​ - (Fill Out Online) - Bring this form to your next appointment with your pediatrician and ask about whether your child might benefit from an occupational therapy evaluation.

2. Release of Information - Complete this form so that Learning Coach can receive information about your child's medical and developmental history to create effective evaluation and treatment planning.

3. Insurance Verification Form​​ - Submit this form so Learning Coach can contact your insurance carrier and send you an estimate of covered services.​

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