Intake Forms

If you were provided with intake forms for individual therapy, please fill our Occupational Therapy Intake Packet before your first appointment. Intake packets are available on our Patient Forms page.

The filled intake packet is required and includes information about the family, environment, medical history, school history, intervention history, developmental history, and family impact.

Cancellations and Missed Appointments

Individual Therapy Sessions

We strive to implement this policy in a reasonable fashion and take into consideration the somewhat unpredictable nature of working with children.

If it is necessary to cancel an appointment, please notify the office as soon as possible. Cancellations should be made at least 24 hours before the appointment.

Subject to therapist availability, if we are able to reschedule your appointment for that same week, we will waive the No Show fees. However, if the therapist is not given sufficient notice (at least 24 hours) and we are unable to reschedule, a charge equivalent to the missed treatment will be applied to your account.

If the child needs to stop therapy for any length of time, his/her regularly scheduled time cannot be promised upon return.

Timely Payments

For individual therapy, we will issue an invoice for services after each treatment. If you provided your credit card information for your account, we will charge the card on file when the invoice is issued. A detailed receipt will be emailed to you.

Payment is considered delinquent if not paid within 2 weeks and are subject to late charges.

Accounts that are past due will necessitate discontinuation of therapy.

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

In the event that your check is returned due to insufficient funds or your credit card is declined, 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 to the returned check.

Credit Card Authorization form is available on our Patient Forms page.

If you have questions about any invoices please direct these questions to our office.

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 possible reimbursement from your insurance company for an out-of-network provider, please provide us with the following to be included with your invoice:

  • Letter of referral or prescription for OT from the referring physician
  • DSM-IV or ICD-10 diagnosis and code number (designated by the physician)

This information will enable us to provide an invoice that is in keeping with your health insurance company’s invoice policies.

We Strongly recommend that you contact your health insurance carrier to inquire about allowable CPT codes for Occupational Therapy services.

Please remember that 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 on 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.

[Date updated: February 15th, 2020]