Patient Forms 2020-04-30T03:56:13+00:00

Patient Forms

Parents can save time during their child’s first appointment by completing the New Patient Packet form prior to their visit. It is a fillable PDF form so you can download it to your computer, fill it and email it back to office@therapyworkspc.com. OR you can simply print out the form, fill in the information requested, and bring the completed form with you to your first appointment.

NEW PATIENT PACKET


Submit Medical Records 

Parents may email their child’s current  Individualized Education Plan (IEP) or Individual Family Service Plan (IFSP) to us at office@therapyworkspc.com or fax it to (770)995-2385.


Medical Records Request

To have medical records released, please complete the Authorization to Disclose Protected Health Information form email it to office@therapyworkspc.com ATTN: Medical Records Request. You can also fax the completed form to (770)995-2379, ATTN: Medical Records.

AUTHORIZATION TO DISCLOSE PROTECTED HEALTH INFORMATION FORM


Telehealth Visits

To give consent to telehealth visits. parents need to print, sign, and email the following form to office@therapyworkspc.com.

INFORMED CONSENT FORM