Forms — Columbia Pediatric Therapy

Please fill out the following forms before coming in for your evaluation.
Click on the links below to fill out each form:

Initial client intake form that we require for all new clients. It helps us get to know your child better prior to the evaluation in order to maximize our evaluation time.

Client Intake Form - Speech Therapy

Client Intake Form - Occupational Therapy

Waiver of Liability Relating to Coronavirus/ COVID-19

Sickness Waiver Form

Forms including photo/video release form, student observation and treatment release form, and activity liability release form.

Parent Signature Forms

These forms include attendance, consent for services, and privacy policy.

We may use the exchange of information form if we are needing to collaborate with other service providers regarding your child's care. If you already know of a provider who would like a copy of your child's information, please feel free to it fill out for that provider. Your child's health information is protected and will not be shared without your consent.

New Client Forms

Client Intake Form - Speech Therapy

Client Intake Form - Occupational Therapy

Sickness Waiver Form

Release Forms

Parent Signature Forms

Consent for Release

of Medical Information

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