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Forms
New Client Forms
Please complete following confirmed appointment.
New and Current Client Forms
Complete these prior to your appointment and annually after starting services.
The HIPAA forms notify you of your protected medical information and our commitment to you confidentiality and your agreement to protect others confidentiality.
We at GTAC are committed to providing the best outcomes for your child. This requires parents to participate. The Parent Training Notification form acknowledges that your child will be in the same room as other children and possibly their parents during therapy. We have alternate locations in the clinic in the event you would prefer a more private therapy session.
The Pick Up Authorization form is the list of people you will allow to pick your child up from our clinic. Legal guardians do not need to be listed but other family does. This will also serve as your child's emergency contact list.
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​The Physical Intervention Consent form is a disclosure of crisis procedures. A more detailed description will be discussed during your intake appointment.
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The Release of Information form is to give us permission to talk with and share records with any person that supports your child that their cooperation would be valuable, examples are Speech Therapy, Occupation Therapy, teachers, doctors, etc. Please put the name of the company and/or person your child sees. If you would like us to collaborate with more than one, please list each on the form separated by a comma (,).
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