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Let's schedule an intake call!

Before we hop on the phone, we like to share a few things about us and get to know a bit more about you! Once completed, we will reach out within 24 hours to schedule a 15 minute intake call.

There is a $50 registration fee for our services. This fee will be applied following our intake call and completion of intake paperwork.

Today's Date:

Date

Our Therapeutic Approach:

Playful Palms Therapy aims to be a neurodivergent affirming practice and LGBTQ+ friendly. We believe being neurodivergent is a part of a person's identity. Neurodivergency is a different way of thinking, learning, and doing.

Our team 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.

Playful Palms Therapy values strong parent partnerships, regular communication, and therapy that is focused on very functional and meaningful objectives. Parents are expected to be active partners in the therapy process. PPT is not the setting to simply drop your child off for a session once a week. We are your partners in this journey to help your child thrive.

We say yes to the mess ... every time. At Playful Palms 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!

Playful Palms Therapy 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 hurricane watch, and extremely high temperatures in the summer that are considered unsafe conditions.

We are NOT the right setting for every child or every family. When you select Playful Palms Therapy to help your child be their best through outdoor occupational therapy, you understand the above is the PPT 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 Playful Palms Therapy Therapeutic Approach.

Yes, I understand.

I understand that Playful Palms Therapy does not work directly with any insurance company. Playful Palms Therapy is a direct provider for the family. It accepts Private Pay only. We can provide Superbills upon request.

Yes, I understand.

Child's Full Name:

First NameLast Name

Child's Birthdate:

Date

Parent/Guardian Full 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 Email:

example@example.com

Where did you hear about Playful Palms 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 their Plan of Care to Playful Palms TherapyNo, we need an OT evaluation

Please upload a copy of your child's most recent Occupational Therapy evaluation if it was within the last 12 months. If your child has completed a neuropsychological evaluation and you wish to share it here to provide more information, please do! (this is different then an OT evaluation).

Which type of services are you interested in joining?

Nature-based social groups1:1 occupational therapy servicesNot sure what the best fit is for our child yetOccupational therapy evaluation

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/elope.My child does not have challenging behaviors that could potentially endanger themselves or others in the woods.My child is able to maintain personal safety with an adult nearby but not always within an arms reachMy child is able to navigate outdoor spaces with minimal physical supportMy child is able to function in a small group with 3-6 kids, given 1:3 ratio adult to child ratio.My child does not yet meet the criteria, but I hope to work with Playful Palms Therapy 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.

If you would like to subscribe to our email newsletter to receive periodic emails from Playful Palms Therapy, please enter your email here! We send tips, resources, and give subscribers first dibs for our services.

I'll add my email at the link below!Not at this time

JOIN OUR EMAIL LIST HERE!

I have filled out this form completely and reviewed it for accuracy. I understand that Playful Palms Therapy will contact me within 48 hours to schedule an intake call.

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