Thank you for your interest in Treeline Occupational Therapy Services.

If you are interested in potentially scheduling please do the following:

1. Complete this form and select your expected availability. 1:1 Session slots are typically offered on a first come first serve basis to those with matching availability if or when a slot opens.

2. Follow the link to schedule a 15-minute informational call with the Treeline administrator. This call is to answer questions and to help you determine if Treeline is a good fit for your family.

Thank you for your interest in Treeline Outdoor Occupational Therapy Services.

At this time, our therapists are fully booked, if you are interested in learning more about our services and joining the waitlist, please:

1. Complete this form and select your expected availability. 1:1 Session slots are typically offered on a first come first serve basis to those with matching availability when a slot opens.

2. Follow the link to schedule a 15-minute informational call with the Treeline administrator. This call is to answer questions and to help you determine if Treeline is a good fit for your family.

3. When a slot opens up matching your availability, you will be contacted to explore if you are interested in onboarding at that time.

Today's Date

Date

Therapeutic Approach

Treeline Enrichment 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.
Treeline Enrichment 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. Treeline 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 (inside and outside). At Treeline Enrichment, 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, water, paint, etc. if they are interested, instead, we WILL play in it with them!

We are NOT the right setting for every child or every family. When you select Treeline Enrichment to help your child, you understand the above is the Treeline 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 Treeline Therapeutic approach (above).*

Yes

All billing is completed at the end of the month for services rendered. I understand that Treeline Enrichment does not work directly with any insurance company. Treeline is a direct provider for the Family Empowerment Scholarship, accepts Private Pay, and will provide a Superbill to a family upon request.*

Yes, we plan to use the Family Empowerment Scholarship (FES-UA ONLY) for services.Yes, we plan to private pay for services.Yes, we plan to private pay for services and will be seeking out of network insurance reimbursement, we request a Superbill.

Your insurance plan must have out-of-network benefits in order for you to be reimbursed for services provided by Treeline Enrichment, as we are not part of any insurance network.

Further, many insurance plans will only reimburse for occupational therapy services if a physician has prescribed them as medically necessary PRIOR to treatment.

Please complete the Letter of Medical Necessity (we highly suggest right-clicking the link and opening it in a new window) form found by visiting our Client Resources Page. It is very important that you check with your insurance provider before starting services to clarify what services are covered, how they are covered, and how they are reimbursed.

Child's Full Name*

First NameLast Name

Child's Gender*

Child's Birthdate*

Date

Parent / Guardian Name*

First NameLast Name

Parent / Guardian Phone Number*

Area CodePhone Number

Parent / Guardian Email*

example@example.com

Where did you hear about Treeline Occupational Therapy? *

Why are you seeking occupational therapy services for your child? *

Are you looking for OT therapy specifically for feeding concerns?*

Yes, feeding is a priority goal for our family.No

Describe any therapy services that your child is currently receiving or has received in the past.*

I understand that Treeline offers outdoor OT services September through May only.

Yes

Treeline is an intentionally small indoor/outdoor therapy practice. Therapists keep small caseloads and schedules are kept light to support therapist health. As a result, the therapy schedule has limited availability. Your schedule flexibility will help you get started with OT more quickly.*

Our schedule can be flexible. I understand that I will have to work around the therapist's availability.Our schedule is NOT flexible. I understand that I will likely have to wait a while for therapy services.

Please indicate DAYS and TIMES (check all that apply) you are generally AVAILABLE. (There is no guarantee a therapist is available on your available days and times).*

	Morning (8:30-11:30am)	Early Afternoon (11:30-2:30pm)	Late Afternoon 3:00-6:00pm)
Monday
Tuesday
Wednesday
Thursday
Friday

I understand that an OT evaluation is required prior to beginning occupational therapy services*

Yes

Does your child have an OT evaluation from a Florida occupational therapist dated within the last 6 months?*

YesNo

If you have had an occupational therapy evaluation within the last 6 months from a Florida occupational therapist, a Transfer Plan of Care option is available to you. This process helps us to get up to speed with your child needs and will help to establish the most current goals and recommendations. The transfer plan of care includes

Review of intake paperwork
Detailed review of OT evaluation
30 minute parent meeting before the child’s 1st therapy session
Transfer and updating therapy goals
Updated plan of care report (finalized after 1-2 OT sessions with us)
Transfer Plan of Care Fee: $150

What is the date of your child's most recent occupational therapy evaluation (or re-evaluation)?

Date

Please upload a PDF copy of your child's most recent OT evaluation.

Browse Files

During the 15-minute informational call, your evaluation options may be discussed.

Standard Evaluation
A complete assessment that provides advanced insight, customized recommendations, and professional perspectives to guide goals and priorities for interventions. If you are new to occupational therapy or Treeline Enrichment, this assessment is for you.

The standard evaluation includes:

Detailed review of intake paperwork and previous reports
Online parent questionnaires
30-minute parent interview before the evaluation
90 minute on-site evaluation session
Therapist time to score, review, and interpret the assessment data
60-minute parent meeting after the evaluation
Parent collaboration on goal development
Comprehensive evaluation report
Standard evaluation fee: $500

Basic Evaluation
Designed to give a baseline of skilled data, dedicated time for collaboration with the caregivers, targeted priorities, and to get your child started with meaningful occupational therapy services.

The Basic Evaluation includes:

Detailed review of intake paperwork and previous reports
Online parent questionnaires
30-minute parent interview before the evaluation
45 minute on-site evaluation session
Therapist time to score, review, and interpret the assessment data
Brief summary evaluation report
Basic Evaluation fee: $300

Behavior Policy

Our therapists use cues of safety, sensory supports, and relationship-based interventions to help children handle big emotions and behaviors.

If a child has disruptive behaviors that impact the safety of themselves or the therapists, we will immediately collaborate with the parents to discuss relationship-based strategies to further support safety in sessions. Should it be decided by the therapist and parent that this location is not a good fit for the child, services will be terminated.

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.

We are on over 10 acres of natural space with access to a pond, barbed wire fence, seasonal creek, 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.

Do any of these statements describe your child? Check all that apply. We will discuss any checked statements during the informational call to explore if the Treeline environment is a good fit yet for your child.*

It would be difficult to navigate 4-6 stairs to enter the indoor facilityMy child runs off / elopes from me or others.My child tries to hurt him/herself, me, or others when upset.My child needs me to be right next to him/her at all times.My child needs physical assistance to navigate outdoor spaces.None of these statements apply

Share comments, questions, or concerns that you have about your child's participation, specifically about the OUTDOOR options at our indoor/outdoor setting.

Would you like to be added to our email list to receive occupational therapy tips and announcement emails from Treeline?*

Yes, definitely!No, but thank you.I'm already subscribed!

I have filled out this form completely and reviewed it for accuracy. I will now schedule a 15-minute informational call with Treeline using the link that will appear when I press submit.*

Getting Started with Occupational Therapy

Behavior Policy