I have read and understand this Fee Schedule/Consent Form and agree to its terms.
SPECIFIC POLICIES
o Admissions – families are encouraged to call to speak with our intake coordinator to set up services. We work with children – infants through early adulthood. There is no specific admissions policy.
o Attendance – our policy states that all clients must be in attendance for 75% of his/her regularly scheduled sessions, in any rolling 3-month period. If the attendance percentage drops below 75%, the regularly scheduled time slot may be forfeited.
o Method of Instruction – we provide individual or group speech therapy or occupational therapy as prescribed by the licensed therapist; we use a variety of evidence-based measures to engage children.
o Nondiscrimination – we do not discriminate based on age, race, color, religion, sex, gender identity or expression, sexual orientation, national origin, or disability,
o Confidentiality – all records are kept in our secure EMR and not shared with anyone unless we have written consent.
o Quarterly IEP progress reports – reports will be done on time and shared with families.
o Withdrawal and transfer – if a family decides to discontinue services with us, a phone call or email letting us know will suffice. We will share appropriate records with the new provider if asked.
o Student discipline and termination – we do not discipline our clients; termination would be based on attendance or an inappropriate fit between client and therapist.