Forms

If you’ve requested an evaluation and have been directed to complete the intake forms, you’re in the right place.

We’re working to move our forms over to a new platform and have PDFs for the time being until our new automations are live.

Simply click the forms required, complete and email to admin@communicationcottagetherapy.com or fax to 843-582-0259

SUBMIT A REFERRAL - START HERE

Please visit the request an evaluation page on our website. Complete and we will be in contact when we can schedule services. You may follow up at any time on referrals submitted.

PRIVATE PAY / CREDIT CARD AUTHORIZATION

If you are requiring services but do not have an insurance that we are able to accept – Please complete the private pay consent form. We would need this one file prior to services being rendered.

INTAKE CONSENT PACKET - BEFORE EVAL

Before getting started with direct services our company requires the completion of this intake packet of consent forms. Please complete and then press submit and we will add these forms to your child’s file.

CASE HISTORY FORM - BEFORE EVAL

Before getting started with services please complete this case history form to help us get to know more about your child and how we can best support you and your family.

COTTAGE LOCATION - CONSENT FORM

Having a new facility is wonderful but there are some general policies and releases that we need to make sure that we share prior to your first session with us. Please complete these forms for updated records.

FEEDING FORM

If you have concerns regarding your child’s feeding and/or swallowing skills please complete this form to provide further information about your child’s experience with eating. Most often your child’s treating therapist will direct you to this form if it is needed to be completed; however, if you want to be proactive and complete this if you have concern we greatly appreciate it and will share the form with your child’s therapist.

RELEASE OF INFORMATION FORM

Our Therapists value coordinating care with other providers on your child’s team! To help us stay up to date with current information (names + contact information) Please complete an updated form when a new provider joins your child’s team.