WE JUST WANTED TO REACH OUT TO LET YOU TO LET YOU THAT WE HAVE UPDATED OUR POLICIES TO REFLECT ALL THE CHANGES THAT HAVE LEAD UP TO 2022 AND ARE REQUESTING ALL OF OUR UPDATED POLICIES & CONSENT FORMS BE FILLED OUT AT YOUR EARLIEST CONVIENCE.
WE APPOLIGIZE FOR ANY INCONVIENCE, BUT WE ARE HOPING QUICK ONLINE FORMS WILL MAKE THIS PROCESS EASIER ON YOU.
JUST A FEW FORMS
KEEPING YOUR INSURANCE INFO UP TODATE
We should already have your insurance card so the next step is simple, just click the button to the side, fill out our Insurance Verification Form.
INTAKE PAPERWORK
HIPAA AGREEMENT
What is HIPAA?
HIPAA is the Health Insurance Portability and Accountability Act (HIPAA).
Which basically means that your child’s private health information (PHI) is protected by federal law. You have rights regarding your child’s PHI and it provides specific rules and regulations on who may have access to it.
INFORMED CONSENT AND CLIENT RIGHTS
Informed Consent is the assured understanding between you and Prism Therapeutic Services, Inc., which confirms that you have made for you/your child the voluntary choice to receive our services. This document provides information about applicable ethical codes and state and federal laws. It is important that you have a clear understanding of what is expected of you and what you can expect from your/your child’s services.
CLIENT POLICIES AND PROCEDURES
Specifically, in consideration for my child’s participation in applied behavior analysis services provided by Prism
CONSENT TO RECEIVE SERVICES DURING COVID-19 & AGREEMENT
This document is to outline the requirements to remain eligible for home based and center based services from Prism Therapeutic Inc., during the COVID-19 pandemic, as well as to outline and inform you of our illness policy.
RELEASE OF INFORMATION
If you need us to share any information with any angency, be sure to fill out this form. This Form is not mandortary.
CONSENT FOR OCCUPATIONAL THERAPHY
This form is consent for Prism to perform assessment and treatment for your child as recommended by an Occupational Therapist.
CONSENT FOR SPEECH LANGUAGE THERAPY
This form is consent for Prism to perform assessment and treatment for your child as recommended by a Speech and Language Pathologist.
PHOTO AND VIDEO CONSENT
This is to allow Prism Therapeutic Services, Inc. and it's representatives and employees the right to take photographs and or video of my child durning therapy sessions for purpose including, but not exclusive to supervision, education/treatment, educational/treatment training.
TOILETING CONSENT
This form is optional. As part of your child’s Applied Behavior Analysis therapeutic program, Prism offers and implements toilet training procedures individualized to your child’s needs and development.
Thank you so much for taking the time to fill out this intake packet to potentially get your child started with services in the near future. One of our staff members will be calling you within 48 business hours to confirm that we got all of your paperwork and let you know of next steps.
If you have any questions please don’t hesitate to call (505)-508-0865 or reply to the email of the person who shared this web page link with you. We are here to answer any questions you may have.