This section has samples of forms for Early Intervention and School Age Therapy programs. These forms serve as examples only, and should be used at the discretion of therapists and administrators. It is recommended that they be modified so they are consistent with the needs, policies and procedures of each organization.
FORMS
Early Intervention Therapy Programs
School-Age Therapy Programs
Referral Forms |
Intake Forms (Form 1, Form 2) |
Consent Forms (Form 1, Form 2, Form 3) |
Progress Notes |
Family Service Plan (Interdisciplinary) |
Multi-disciplinary Reports (Form 1, Form 2, Form 3) |
Background Student Information |
Functional Classification Summary (CP only) |
Functional School Screening Form |
Moving Students Safely: Assessment, Recommendations and Review (Link 1, Link 2) |
OT/PT Consult Charting |
OT/PT Progress Charting |
School Therapy Competency Performance Review |