Forms

Welcome to Special Therapies, Inc. Our New Patient forms are found below. Please print and complete each form in the appropriate section. We appreciate your time in completing these forms prior to your appointment. The forms can be returned via mail, e-mail, fax or personal delivery.

New Adult Patient Forms

New Child Patient Forms

New Patient Registration

HIPAA Guidelines and Acknowledgement

Insurance Claim Submission Form

Adult Case History Form

New Patient Registration

HIPAA Guidelines and Acknowledgement

Insurance Claim Submission Form

Child Case History Form

Infant Case History Form

What Should I Bring to My First Appointment?

Original insurance card to be photocopied, if requesting that Special Therapies submit insurance claims.

Physician Referral/prescription, if available. (If not, we can request this after the initial evaluation. In this case we will need the name of your primary care physician.)

Any Special Therapies forms that you have not previously returned.

Feel free to also submit other reports that may be helpful (i.e., educational, psychology, medical)

Additional questions? Click here.