Arlington Pediatric Therapy
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  • More
    • Home
    • About Us
      • About Us
      • Lurie Children's
      • Our Clinic
      • Testimonials
    • Our Services
      • Occupational Therapy
      • Speech Therapy
      • Physical Therapy
      • Aquatic Therapy
      • Sports Medicine
      • Social Work
      • Feeding Clinic
      • Pelvic Health Program
    • Our Staff
    • Groups & Classes
      • All Groups & Classes
      • Feeding Clinic
      • Pelvic Health Program
      • Behavioral Skills Group
      • Social Skills Group
      • LEGO Club
    • New Patients
      • New Patient Forms
    • Pay My Bill
Arlington Pediatric Therapy
  • Home
  • About Us
    • About Us
    • Lurie Children's
    • Our Clinic
    • Testimonials
  • Our Services
    • Occupational Therapy
    • Speech Therapy
    • Physical Therapy
    • Aquatic Therapy
    • Sports Medicine
    • Social Work
    • Feeding Clinic
    • Pelvic Health Program
  • Our Staff
  • Groups & Classes
    • All Groups & Classes
    • Feeding Clinic
    • Pelvic Health Program
    • Behavioral Skills Group
    • Social Skills Group
    • LEGO Club
  • New Patients
    • New Patient Forms
  • Pay My Bill

New Patient Intake Forms

Consent for Care and Services (pdf)

Download

AP Federal and State Mandatory Patient Notices (pdf)

Download

AP Notice of Privacy Practices Summary (pdf)

Download

AP Plain Language Summary (pdf)

Download

Notice of Privacy Practices Pamphlet (pdf)

Download

Surprise Billing Disclosure (pdf)

Download

Surprise Billing Self Pay Notice (pdf)

Download

Other Forms

12 Week Welcome Letter (doc)

Download

Aquatic Therapy Consent Form (doc)

Download

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