Forms
To begin therapy services, you may start by completing our Referral Form below. Once we receive the completed form we will contact your child’s primary pediatrician to be signed. After receiving the signed doctor’s order we will contact you to set up the initial evaluation. Please note, it can take up to two weeks to get the doctor’s order signed. In the meantime if you have any questions please don’t hesitate to contact our office at (803) 869-0077.
Printed forms can be faxed to (803) 228-0101 or mailed to 1612 Ebenezer Rd, Suite 101, Rock Hill, SC 29732
Thank you!
Referral Form
This form is for those who are interested in requesting a screening or evaluation.
Download form: 
New Client Intake Form-
This form is for all new clients who have been scheduled for an upcoming evaluation.
Download form:
English Forms
- How to Use Fusion Patient Portal
- TW Request for Services Form
- TW Attendance Policy Form
- TW Case History Form
- TW Consent to Video-Tape and Photograph Therapy Sessions
- TW Covid-19 In-Person Therapy Waiver
- TW Financial Policy
- TW HIPPA Communication Compliance Form
- TW HIPPA Compliance Form
- TW Intake Forms
- TW New Patient Data Form and Financial Policy
- TW New Patient Data Form
- TW- Physician Order Form Packet
- TW What to Expect during the Evaluation