Insurance and Payments

Helping You Find Resources

We are dedicated to helping you find alternative funding sources for which may qualify.
Ms. Kim at the front desk has a wealth of information about local programs, scholarships, and grants that may apply to your unique situation.

Some alternate funding sources include:

  • Jon Peterson Special Needs Scholarship Provider (Link to info)
  • United Healthcare Children's Foundation
  • Miami Valley Down Syndrome Association
  • Greene County Family Resource Funding
  • Other local and federal grants

Forms of payment

We accept cash, check, Mastercard, Visa, and Discover for payment of therapy services. We appreciate the opportunity to make payment as convenient as possible for you.

Ms. Kim
Ms. Kim has been helping families at Therapy Connections since 2001.

Forms to Get Started

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

01

Case History Form

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

02

Consent for Services Form

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

03

Cancellation and No Show Policy

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

04

Arbitration

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

05

Release of Information

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

06

Insurance Information

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

07

Orthopedic Therapy Form

For orthopedic therapy cases, provides complete medical history pertinent to therapy services.

Other Specialty Forms - Only if your therapist asks you to complete:

08

Therapeutic Listening Followup

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