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Service Intake Forms
 

Intake and Medical Communication:

  1. Insurance Verification Form (online​​) (print)

  2. Release of Information (online) (print)

  3. Doctor Referral Form (online) (print)​​

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Before Evaluation

  1. Intake Questionnaire (online) (print)

  2. Electronic Communications Policies (online) (print)​​

  3. Financial Responsibility Form (online) (print)

  4. Credit Card Authorization Form (online) (print)

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Before Treatment

  1. Learning Coach LLC Practice Policies (online) (print)

  2. Informed Consent for Occupational Therapy (online) (print)

  3. Telehealth Consent Form (online) (print)

Schedule a Free Phone Consultation

Talk with Learning Coach about your current life situation, your ideal  life situation, the obstacles between them, and the path ahead.

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