Forms

To help expedite the intake process, we ask you complete your paperwork prior to your first appointment.

Patient Forms - 4 Steps
  • Facility Policy
  • Patient Information
  • Insurance Information
  • Consent To Treat

Facility Policy

Welcome to 321go Kids Rehab therapy. Please read the following general information and guidelines.

Paperwork: All intake forms should be completed and signed prior to treatment.

Payment Procedures: Arrangements for insurance billing must be made prior to beginning a therapy package. A schedule for co-pays or private payments should be made before starting the therapy package. We accept cash, checks and credit cards.

Therapy Sessions: Length of session will be determined on an individual basis. As a general format, therapy sessions are scheduled in 30, 45, or 60 minute blocks. This includes 10 minutes of documentation and communication time with the family/caregivers.

Observing Therapy: We are happy to have family and friends of clients observe treatment sessions as long as it does not distract the client. In order to keep the integrity of the session, we ask that you do not interrupt or distract the client during therapy. Please also be aware that other clients may also be receiving therapy in the gym at the same time as you. Any pictures you take of your family member may not include pictures of the other clients in the clinic without the strict permission of the parent or guardian of the other client.

Arrival for Therapy: Please arrive 5-10 minutes prior to your therapy session making sure bathroom breaks and/or nutritional needs have been met. We invite you to relax in our family waiting room until our therapist are ready for your appointment time.

Food in the Clinic: Due to the many clients, we serve, we ask you keep food/snacks and beverages outside of the clinic (some of our families have food allergies). Peanut/Latex allergies is a serious concern for some of our patients and we want to be aware of this. Also, If you must have a drink, we ask it be kept in a water bottle or sippy cup with a guard on it. Clients and their families are welcome to use our water cooler located near the bathroom. Please bring your own water bottle.

Interns and Students: There will be instances when students from universities, colleges, and/or students job shadowing will be present and engaged in treatment sessions with your child. Communication and arrangements will be addressed prior to these individuals participating in your child’s treatment session.

Cancellations/Late Arrivals: If you need to cancel a treatment session, we ask for at least 24-hours’ notice. Please call (765) 591- 4190. We will strive to offer a make-up time within the week. If you are late to a session the therapist may not be able to see you for the full session or you may be asked to reschedule. FOCUS packages will not be extended for multiple cancellations or late arrivals, except in extenuating circumstances.

Supervision of Children: Other children may accompany parents to a therapy session. Parents are responsible for supervision of these children at all times.

Pets: Due to our commitment to safety of our clients, no pets are permitted on the premises. The exception to this would be the use of service animals.

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