OT by Roni Casser Inc.
Therapeutic Connections

Therapeutic Connections is a private pediatric Occupational Therapy practice that specializes in increasing self-esteem and frustration tolerance which facilitates success in the 3 main activities of children: playing/socializing, academic skills, and positive family relationships.

Intake FormsThe purpose of the Initial Intake Form is to provide Therapeutic Connections with the all information we need to evaluate your child so we may design an inclusive treatment plan based on your child's individual needs. We require information in the following areas:

  • Patient Information
  • Background information
  • Prenatal / Birth History
  • Developmental History
  • Speech - Language Developmental
  • Medical History
  • Educational Background
  • Functional Status
  • Sensorimotor History

The form also covers the Attendance Policy and Payment Policy for Therapeutic Connections.
The Intake Insurance Form is used only for the purposes of Therapeutic Connections insurance and payment obligations. We require information in the following areas:

  • Patient Information
  • Insurance Information

Choose an Option Below

  • Download and print Adobe PDF forms, fill them out and bring them to your first appointment.
  • Open Microsoft Word forms, fill them out, save document, and return as an email attachment.
Intake Form
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Intake Form
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Insurance Form
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Insurance Form
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