PATIENT FORMS

To expedite the process to obtain Occupational Therapy Services, all new patients need to complete and sign the following forms via Docusign (Electronic Signature) before your first appointment.

NEW PATIENT INTAKE

Click DocuSign button below to complete and sign new patient intake form.

TELETHERAPY CONSENT

Click Docusign button below to complete and sign teletherapy consent form.

COVID-19 

CONSENT 

Click Docusign button below to complete and sign teletherapy consent form.

INSURANCE AUTHORIZATION

Click DocuSign button below to complete and sign insurance authorization

TREATMENT

CONSENT

Click DocuSign button below to complete and sign consent authorization form.

PRIVACY RIGHTS

Click Download button below to get to know your privacy rights.

Connected Kidz _ Pediatric Occupational

Copyright © 2020 | Connected Kidz, LLC | All rights reserved

t. 803-620-9702 | f. 803-620-9722

1803 Ebenezer Rd., Rock Hill, SC 29732

Business Hours: 8:00 am - 5:00 pm (EST) Mon - Fri

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