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  • 803-228-0101
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  • About Us
    • Our Team
    • Our Partners
    • Gallery
  • Services
    • Speech Therapy
    • Occupational Therapy
    • Feeding Therapy
    • Physical Therapy
    • Sensory Social Groups
    • Coaching Classes and Workshops
  • Get Started
    • New Patients
    • Our Process
    • Existing Patients
    • Forms
      • English Forms
      • Formularios en Español
    • Insurance Information
    • FAQs
  • Resources​
    • Developmental Milestones
    • Community Resources
  • Join Us
    • Employment
    • Internship
    • Volunteers
  • Contact Us
  • Review Us
English Forms

Let’s Start Working Together.

Medical forms are an important part of patient records. They help our team understand your child’s health concerns, family health history, manage billing, and protect your privacy. It is important that you provide accurate information at your first visit to help your therapist and other team members coordinate the best decisions for your plan of care.

  • Request for Services Form
  • Physician Order Form
  • What to Expect during the Evaluation
  • How to Use Fusion Patient Portal
  • Case History Form
  • New Patient Data Form and Financial Policy
  • Attendance Policy Form
  • Consent to Video-Tape and Photograph Therapy Sessions
  • HIPPA Communication Compliance Form
  • HIPPA Compliance Form
  • Intake Forms Packet

MENU

  • About Us
    • Our Team
    • Our Partners
    • Gallery
  • Services
    • Speech Therapy
    • Occupational Therapy
    • Feeding Therapy
    • Physical Therapy
    • Sensory Social Groups
    • Coaching Classes and Workshops
  • Get Started
    • New Patients
    • Our Process
    • Existing Patients
    • Forms
      • English Forms
      • Formularios en Español
    • Insurance Information
    • FAQs
  • Resources​
    • Developmental Milestones
    • Community Resources
  • Join Us
    • Employment
    • Internship
    • Volunteers
  • Contact Us
  • Review Us
  • About Us
    • Our Team
    • Our Partners
    • Gallery
  • Services
    • Speech Therapy
    • Occupational Therapy
    • Feeding Therapy
    • Physical Therapy
    • Sensory Social Groups
    • Coaching Classes and Workshops
  • Get Started
    • New Patients
    • Our Process
    • Existing Patients
    • Forms
      • English Forms
      • Formularios en Español
    • Insurance Information
    • FAQs
  • Resources​
    • Developmental Milestones
    • Community Resources
  • Join Us
    • Employment
    • Internship
    • Volunteers
  • Contact Us
  • Review Us

CONTACT US

Our Rock Hill location:
1612 Ebenezer Road
Suite 101
Rock Hill, SC 29732
 
Our Cornelius location:
9624 Bailey Road
Suite 273
Cornelius, NC 28031
 
Our Charlotte location:
8301 University Executive Park Drive
Suite 170
Charlotte, NC 28262

  • (803) 329-9500
  • 803-228-0101
  • support@mytherapyworld.com
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