If you would like to have your child evaluated for a communication problem at Holland Pediatric Therapy, please read the following information to help you begin this process. If you have any questions, please contact us at 405-308-9120 or by email at [email protected]
- Complete and return the Client Intake Form.
- Complete and return the Case History Form.
- Read, sign, and return the Notice of Privacy Acknowledgement and Consent form.
- For clients referred for feeding difficulties, complete these forms.
If your child is covered through Soonercare/Medicaid, these additional forms are needed:
- A prescription for services and current clinic note completed by the child’s primary care physician. These can be faxed directly to our office at (405) 708-5353.
- A copy of the child’s Medicaid card.
- A copy of the child’s Individual Family Services/Support Plan (IFSP) or Individual Education Plan (IEP), if applicable.