North Texas Therapy Innovations, P.C.

New Patient Packet - Contents

•  Welcome Letter
• Patient Information Form (1page)  - Complete & Return
• Clinic Policies (4 pages) - Complete & Return
• Credit Card Acceptance Form (2 pages) - Complete for credit card payments, attach a copy of your credit card and driver's license.
• Authorization of Use/Disclosure (2 pages) - Complete & Return
• Sensory Motor History (5 pages) - Complete & Return
• Clinic Maps (2 pages) - Keep
• Parent Book List (1 page) - Keep
• Notice of Privacy Practices (3 pages) - Keep

2009 Patient Update Packet for existing clients; annual update.

Speech Patient Attachment to Packet required in addition to New Patient Packet for Speech Clients.

HIPAA Release Form required for conversations with teacher, counselors etc.

Credit Card Acceptance Form allows you to make your payments by credit and debit card.

The forms are all in pdf format.  You will need Adobe Reader to open the files. You can download Adobe Acrobat Reader free from www.adobe.com

Please download the appropriate forms, complete the forms and bring them with you completed to your appointment.  The forms are an important part of your evaluation.