Forms

Cargo

New Patient Forms

Please download, print, and complete the following documents prior to your first appointment.

Case History

Provides important background information about your child, including complete medical history and developmental history.

Consent for Services

Discusses important Therapy Connections policies and provides authorization for our team to evaluate and/or treat your child.

Cancellation and No Show Policy

Important information about our policy for missed, late, and cancelled appointments due to various circumstances.

Arbitration

Agreement for how any disputes or controversies will be handled between Therapy Connections, LLC and patient and/or patients' parents or legal guardians.

Release of Information

Authorization to release medical records, testing, and other information necessary to provide treatment to your child.

Insurance Information

Provides us with a complete list of your applicable insurance so that we may appropriately handle any billing.

Other Forms

Other Forms

Please download, print, and complete the following documents as requested by your therapist

Therapeutic Listening Followup

Provides feedback on how your child responded to our Therapeutic Listening Program.

Autism Spectrum Apps

List of apps available to help children on the autism spectrum.  Includes a short description of each app, cost, and compatability with devices.

Therapy Connections

We provide a range of services under the categories of Speech Therapy, Occupational Therapy, and Physical Therapy to children of all ages and various diagnosis. We provide customized programs & education focused on achieving positive outcomes.


Hours

  • Monday - Friday: By appointment

 

CONTACT INFORMATION

 Address:
2498 Dayton Xenia Rd. | Beavercreek, OH 45434

 Email:
therapyconnections@sbcglobal.net

 Phone:
(937) 427-1919

 Fax:
(937) 427-1949

©2018 Therapy Connections, LLC. All Rights Reserved.

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