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FORMS



Instructions for Intake Form
Patient Service Agreement
Child Case History Form
Consent and Release Form
Health Insurance Benefits Worksheet
Occupational Therapy Speech Therapy Physical Therapy Our Staff Contact Us Resources

We look forward to the opportunity to assist you!

If you would like to schedule an appointment at our Eagan or Apple Valley clinics, please call 651-994-9644. For general questions we welcome you to call either site.

For your convenience, you may download the forms and complete them on your computer and email them to us prior to your appointment. To view a form, click on the name of the file on the left to open it (Adobe Acrobat Reader is needed, click the logo for a free download). You will then be able to complete the forms and save and email them to us (two weeks prior to your appointment) to:
info@childrenstherapyctr.com .

We currently participate with most insurance plans. Our participation, allows for the highest benefit of coverage for our clients, however, this does not guarantee coverage. Please contact your insurance company regarding your specific benefits.







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