New Patient Forms

Please download, print, and complete the following documents prior to your first appointment.

Case History

Provides important background information about your child, including complete medical history and developmental history.

Consent for Services

Discusses important Therapy Connections policies and provides authorization for our team to evaluate and/or treat your child.

Cancellation and No Show Policy

Important information about our policy for missed, late, and cancelled appointments due to various circumstances.

Arbitration

Agreement for how any disputes or controversies will be handled between TC and patient and/or patients’ parents or legal guardians.

Release of Information

Authorization to release medical records, testing, and other information necessary to provide treatment to your child.

Insurance Information

Provides us with a complete list of your applicable insurance so that we may appropriately handle any billing.

Orthopedic Therapy Form

Provides us with a complete list of your applicable insurance so that we may appropriately handle any billing.

Specialty Forms

Please download, print, and complete the following documents prior to your first appointment.

Therapeutic Listening Followup

Provides feedback on how your child responded to our Therapeutic Listening Program.

Autism Spectrum Apps

List of apps available to help children on the autism spectrum. Includes a short description of each app, cost, and compatability with devices.

Contact Us

Contact Info

  • 2498 Dayton Xenia Rd.
    Beavercreek, OH 45434

  • Phone: (937) 427-1919

  • Fax: (937) 427-1949
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To Cancel or Change Your Appointment

1.937.427.1919

To make, change, or cancel an appointment, please contact our office by phone.