Getting Started with OT

Today's date

MonthDayYear
Date
Getting Started with Occupational Therapy.

Thank you for your interest in EXPLORE Pediatric Therapy. Please complete this form. Following form completion we will schedule a 15 minute discovery call. Once registered, there is a $100 fee to hold your child's place for our School Year services. This fee will be applied to your first month's tuition once the services begin. Groups start the week of September 15, 2024 and end on Friday, June 13, 2025.
Therapeutic Approach:
- EXPLORE Pediatric Therapy aims to be a neurodivergent affirming practice. We use identify-affirming language (i.e. autistic child) and not person-first language (child with autism) because we believe being neurodivergent is a part of their identity. Neurodivergency is a different way of thinking, learning, and doing.
- Our therapists use cues of safety, sensory supports, and relationship-based interventions to support children in sessions. We are not a setting that subscribes to compliance-based ABA principles and strategies.
- We are a play-based setting that is motivated to work with your child's strengths and in their unique areas of interests.
- EXPLORE Pediatric Therapy values strong parent partnerships, regular communication, and therapy that is focused on very functional and meaningful objectives that the parent helps to write. Parents are expected to be active partners in the therapy process. EXPLORE is not the setting to simply drop your child off for a session once a week and that's it. We are your partners in this journey to help your child thrive.
- We say yes to the mess ... every time. At EXPLORE Pediatric Therapy, your child will leave therapy sessions a little (or a lot) dirty (or wet), sometimes stinky, and sometimes a little tired. We will not ask your child to NOT play in the mud if they are interested, instead, we WILL play in the mud with them!
- EXPLORE is an all-weather setting. Therapy sessions take place in the heat, cold, rain, wind, and sun. We shelter under tarp forts from heavy downpour rain. We embrace all of these weather variables as opportunities in the therapy process. The two variables that would result in a cancellation of services is extremely high winds, and extremely low temperatures in the winter that are considered frostbite conditions.
- We are NOT the right setting for every child or every family. When you select EXPLORE Pediatric Therapy to help your child be their best through outdoor occupational therapy, you understand the above is the EXPLORE therapeutic approach and you are ready for your child to grow and learn and thrive under these principles.
I have read and agree with the EXPLORE Pediatric Therapy Therapeutic Approach.
I understand that EXPLORE Pediatric Therapy does not work directly with any insurance company. EXPLORE is a direct provider for the family. It accepts Private Pay only.

Yes I understand.
Are you a returning EXPLORE Pediatric Therapy Occupational Therapy client?

Yes we have participated in group or seasonal services beforeNo
Child's Full Name

First NameLast Name
Child's Birthdate
Parent/Guardian Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Phone Number
Please enter a valid phone number.
Parent/Guardian E-mail
example@example.com
Where did you hear about EXPLORE Pediatric Therapy?
Why are you seeking Occupational Therapy services for your child?
Describe any therapy services your child is currently receiving, or has received in the past.
I understand that an OT evaluation is required by state law prior to beginning occupational therapy services. Does your child have a current OT evaluation that is 12 months or newer?

Yes, we have a current OT evaluation that is less than 12 months old and would like to Transfer the Plan of Care to EXPLORE Pediatric TherapyNo, we need an OT evaluation
If your child is currently receiving OT services or has completed an OT evaluation from a Massachusetts occupational therapist in the last 12 months, what is the date of your child's most recent occupational therapy evaluation or re-evaluation?
Please upload a copy of your child's most recent Occupational Therapy evaluation if it was within the last 12 months

Cancelof
Which type of services are you interested in joining?

After School Therapy Group: Plymouth Location on Monday'sAfter School Therapy Group: Duxbury Location on Tuesday'sAfter School Therapy Group: Marshfield Location on Wednesday'sAfter School Therapy Group: Norwell Location on Thursday'sAfter School Therapy Group: Milton on Monday’sAfter School Therapy Group: Hingham on Monday’sAfter School Therapy Group: Middleborough on Tuesday’sOccupational Therapy Evaluation
We have a waitlist group for the following locations: Please check if you are interested

After School Therapy Group: CohassetAfter School Therapy Group: SandwichAfter School Therapy Group: Hanson
Which Tier Package Pricing are you interested in for your child?

Tier 1 - $400/monthTier 2 - $500/monthTier 3 - $650/monthUnsure
Behavior Policy:

Our therapists use cues of safety, sensory supports, and relationship-based interventions to help children handle big emotions and behaviors. Children who attend our services must be able to follow simple directions (most of the time!), and have basic safety awareness to be in wild nature settings with the therapist but NOT always within arm’s reach.

Our groups take place on acres of natural space with access to rivers, streams, ponds, elevation changes, trees, and natural hazards like thorny plants and potential animals. This is not an ideal environment for children who have significant behaviors or support needs for safety in this setting. If a child has disruptive behaviors that impact the safety of themselves or the therapists in this environment, we will immediately collaborate with the parents to discuss relationship-based strategies to further support safety in the environment. Should it be decided by the therapist and parent that this setting is not a good fit for the child, services will be terminated.
Please verify by checking EACH box that matches your child's abilities.

My child is able to stay with an adult or group and does not run off / elopeMy child does not have challenging behaviors that could potentially endanger themselves or others in the woodsMy child is able to maintain personal safety with an adult nearby but not always within arms reachFor small group: my child is able to navigate outdoor spaces with minimal physical supportFor small group: my child is able to function in a small group with 3-6 kids, given a 1:3 adult to child ratioMy child does not yet meet these criteria, but I hope to work with EXPLORE in the future.
Please leave any comments, questions, or concerns you have about your child's participation in outdoor occupational therapy based on the above behavior policy.
Would you like to subscribe to our email newsletter to receive periodic emails from EXPLORE Pediatric Therapy?

Yes please sign me up!Not at this time
I have filled out this form completely and reviewed it for accuracy. I will now schedule a 15-minute informational call with EXPLORE using the link that will appear when I press submit

Powered by Jotform SignClear

Getting Started with Occupational Therapy.