NEW PATIENT INFORMATION

How can I get my child in to be seen?

For families seeking Occupational and/or Physical Therapy Services for their children we need the following:

1. A prescription/written referral.

You will need to obtain a prescription from your child’s physician for the evaluation and/or therapy services. Please contact the doctor directly to request the prescription to be faxed to our office at 541-770-9212. The prescription will need to include the following:

  • The diagnosis code. (ICD10 code)
  • The frequency and duration of recommended visits. (i.e. 1-2 times weekly for 12 months).

If it doesn’t include the above we will be unable to proceed further as insurance will reject it and reject any request for visits.

2. Fill out and return our New Patient Packet

Please select from the options below to download a New Patient Packet. These are fillable forms which, after being downloaded, can be completed, saved and emailed back to our confidential email at MCT@nt4kids.org. *In order to save your progress on a form, you will need to have an up-to-date version of Adobe Reader for your computer’s operating system.

These forms can also be downloaded, printed and then the completed form can be faxed or mailed to our office at 400 Crater Lake Avenue, Medford, OR 97504

New Client Packet OT & PT

VERY IMPORTANT!
If you are going to be seen for Occupational Therapy you must also download and send in this additional sensory motor and communication/language questionnaire
Occupational Therapy Questionnaire. We need this in addition to the above packet before we can proceed with getting you in for the initial evaluation.

Once we receive your completed paperwork and the prescription from your doctor, our scheduler will contact you to schedule an appointment for the initial evaluation. If we are billing your insurance company, it will be helpful for you to contact your insurance company for benefit and coverage information so you are aware of what will be covered. We will also contact your insurance company to verify benefits. This is not a guarantee of coverage by your insurance company, but will give us helpful coverage information.