We’re Hiring OTs! Join Our Team
A To Z Pediatric Therapy
HomePatient Documents

Patient Documents

Online Forms

  1. New Patient Intake
  2. Consent Form
  3. Attendance & Cancellation Policy
  4. Release of Confidential Information
  5. HIPAA Privacy Notice
  6. Media Release
  7. Payment Policy
  8. Credit/Debit Card Authorization (print and return to office)
  9. Parent/Guardian Questionnaire(s) for desired service(s) (section below)

Online Questionnaires

Downloadable PDF Forms

  1. 2026 New Patient Intake Form PDF
  2. 2026 Consent Form PDF
  3. 2026 Attendance + Cancellation Policy PDF
  4. 2026 Release of Confidential Information PDF
  5. 2026 HIPAA Privacy Notice + Notice Acknowledgment PDF
  6. 2026 Media Release PDF
  7. 2026 Payment Policy PDF
  8. Credit/Debit Card Authorization PDF
  9. Parent/Guardian Questionnaire(s) for desired service(s) (section below)

Downloadable PDF Questionnaires

 

2026 Updated Forms for Current Clients

  1. 2026 Patient Info/Insurance Update
  2. Consent Form
  3. Attendance & Cancellation Policy
  4. Release of Confidential Information
  5. HIPAA Privacy Notice
  6. Media Release
  7. Payment Policy
  8. Credit/Debit Card Authorization (print and return to office)
  9. Acknowledgement of Coverage & Benefits
Share
Tweet
Share
Pin
0 Shares

Phone Number

Phone: (678) 733-9318 Text: (678) 733-9318

E-mail

Address

5825 Glenridge Dr. Building 1, Suite 133
Atlanta, GA 30328

Get In Touch For More Information

  • This field is for validation purposes and should be left unchanged.
Scroll Back to Top