Intake Forms

Please fill our Occupational Therapy Intake Packet before your first treatment. The intake packet includes information the family, environment, medical history, school history, intervention history, developmental history, and family impact.

Cancellations and Missed Appointments

If it is necessary to cancel an appointment, please notify the office as soon as possible. Cancellation should be made at least 24 hours before the appointment. If the therapist is not given sufficient notice and is expecting the child, a charge equivalent to the missed treatment will be applied. We strive to implement this policy in a reasonable fashion and take into consideration the somewhat unpredictable nature of working with children. If the child needs to stop therapy for any length of time, his/her regularly scheduled time cannot be promised upon return.

Our therapy groups are dependent upon consistent attendance of all group members for them to be successful; therefore, we cannot offer refunds or make-ups for missed group meetings, but will provide missed content to parents and provide reviews within the class.

Timely Payments

Payment will be due at the time of treatment. Payments are considered delinquent if not paid within 15 days and are subject to late charges. Accounts that are past due will necessitate discontinuation of therapy. If you have questions about any invoices please direct these questions to our office. In the event that your check is returned due to insufficient funds, you will have 7 days from the time you are notified to make alternative payment arrangements. You will be responsible for any bank fees or charges incurred due the returned check.

If your child is being evaluated for services, we require full payment at the time of the assessment.

Policy Regarding Insurance Reimbursement

Tumble N’ Dots is not part of any insurance program or network. We will not bill insurance providers directly. The child’s family is responsible for all services rendered. If you wish to pursue reimbursement from your insurance company please let us know in advance. In order to generate an invoice that your insurance company will accept, you will need to provide us with the following:

  • Letter of referral or prescription for OT from the referring physician
  • DSM-IV or ICD-10 diagnosis and code number (designated by the physician)
  • The complete name of the insured policy holder to be recorded as the billable party

We Strongly recommend that you contact your insurance company to inquire about allowable CPT codes for OT services.

This information will enable us to provide an invoice that is in keeping with your insurance company’s invoice policies. Please remember that monthly payments are due at the time of receipt regardless of delays in reimbursement by insurance providers. If additional documentation is required by your insurance provider a charge will be made based upon therapist time.

Billing questions

If you have any questions related to billing please contact our office.

Professional Waivers

Each therapist in this office is an independent practitioner who is not responsible for the practice or liability of any other therapist in this office.