Appointment Policy Form

Appointment Policy and Other Expectations

Pediatric Potentials would like to welcome you. The following is a summary of our policies.

  1. Appointments are scheduled into available standing appointment slots. Once you have been scheduled into an appointment time, the therapist has committed this time to you. If you feel this time is not working for your child and/or family, please communicate with your therapist for adjustments and we will make accommodations as available.
  2. If you are unable to keep a scheduled appointment, you must give ample notice (within 2 hours of the appointment time). Any cancellation with less than a 2 hour notice, including no show appointments will be charged a $35.00 fee. Please be advised that we will not bill your insurance for these fees since most health plans do not cover charges of this nature. This means that you will be held responsible for payment. These fees are due at the time of your next scheduled visit.
  3. If your child is seen at their preschool or daycare, and your child is not in attendance on the scheduled day of therapy, it is your responsibility to contact the therapist to inform of a cancellation for that day. Should you neglect to contact the therapist, then the no show policy and fee will be charged to you.
  4. Because insurance benefits vary, it is suggested that you check with your insurance company regarding benefits for Occupational Therapy and if there is any authorization required.
  5. As in accordance with clinic policy and for the respect of other patients, no children (other than those being treated by the therapist) are allowed in the gym or treatment rooms. Please keep any visiting children in the waiting area.
  6. Please remember that we work with medically vulnerable children. If your child is sick, please cancel. If a family member is sick and you are receiving a home visit for therapy, please cancel.

Please feel free to discuss any special circumstances with the therapist. Thank you for choosing Pediatric Potentials, we are pleased that you and/or your physician have chosen us to help you with your treatment and rehabilitation.

Thank you for reviewing and agreeing to these policies. We look forward to seeing you at your appointment.