I understand that a $75.00 non-refundable deposit is required to reserve an evaluation appointment. Please call POTS with your credit card number (Mastercard or Visa) to secure your spot. This non-refundable deposit will be credited to the evaluation fee. I understand that until the fee is submitted the evaluation spot can be withdrawn.
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I agree to submit the New patient Intake Form, Release form, Financial policies, POTS policies and HIPAA form and any material that I would like the evaluator to review not less than 3 days before the evaluation appointment.
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I agree to send or bring in a prescription from my child's doctor before or at the time of the evaluation appointment. It can be sent to info@potsot.com or faxed to 2101-837-9465.
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I understand that cancelations within 24 hours of a scheduled appointment will result in a $75.00 charge to my credit card, unless the session is made up within 7 days.
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I understand that only one parent may accompany a child into the evaluation session as Covid precautions are in effect.
INTIALS

I have read each paragraph and agree to abide by the evaluation policies set forth by Pediatric Occupational Therapy Services, LLC.