WE JUST WANTED TO REACH OUT TO LET YOU KNOW YOUR CHILD IS MOVING CLOSER TO THE TOP OF OUR WAITLIST.

HOORAY!

AT THIS TIME WE WOULD LIKE TO OBTAIN MORE INFORMATION SO WHEN A SPOT DOES OPEN UP, WE WILL HAVE EVERYTHING WE NEED TO START YOUR CHILD WITH SERVICES, AND NO TIME IS WASTED.

Next Steps

TOUR

You have completed your tour at one of our centers, and have confirmed that Prism feels like the right fit for not only your child but for you family as well.

LET’S VERIFY YOUR INSURANCE

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 and a staff members will reach back out to you if their is any further questions or any co-pays you need to be made aware of. If a staff member does not contact you about your insurance then we have all the infomation we need and nothing unexpected came up. Our goal is to make this process as stress-free as we can for you and your family. 

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.

AUTHORIZATION TO PICK UP

This form is for us to get an approved list of who has permission to pick up you child. Please list any one that you think might pick up your child. Please include name, make and model of the vehicle, and a working phone number for them.

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 but needed if you would like Prism to help your child with toileting.

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.