Therapy Agreement

Therapy Cancellation Policy

Please remember that careful, individual planning and time goes into preparing for your child’s therapy. Your therapist aims to maximize your child’s potential and progress with consistent therapy sessions. Consistent attendance is essential to your child achieving therapy goals and receiving the full benefit from his/her therapy plan. Please note that our therapists only get paid for completed therapy sessions, so cancellations negatively affect their income and frequent cancellations may cause financial hardship. Please thoroughly read and initial next to your responsibilities.

 

Excused Absences

Sessions canceled more than 24 hours prior to the session start time.

-Emergency cancellations- due to emergencies such as illness, illness of a family member/guardian, or death in the family.

-Non-emergency cancellations- appointments that are that are due to non-emergencies such as pre-planned medical appointments, family events, lack of babysitter/nanny.

 

Unexcused Absences

-If you arrive more than 15 minutes late to a scheduled appointment (without calling/texting).

-Appointments that are canceled less than 24 hours before the session start time.

 

Excessive Absence

-3 or more unexcused absences per 6 months.

-More than 20% absences of scheduled visits per 12 week period covered
by the current treatment plan.

 

Cancellation

In the event of a cancellation, I will provide as much notice as possible by calling or texting 336-262-6132. If the session is not cancelled 24 hours before session start time, I understand it will be counted as an unexcused absence.

I am responsible for attending therapy sessions as scheduled. I understand that an accumulation of 3 unexcused absences or excessive absences during a Treatment Plan period will result in one of the following:

-My child can be placed on hold.
-My child can be placed back on the waiting list.
-My child can be discharged from therapy.

I understand that I may receive an email/text reminder the day before my scheduled appointment, as a courtesy. I recognize that my attendance is not dependent upon the receipt of an email/text reminder.

I have read, understand, and agree to Therapy Consortium’s Attendance and Cancellation Policy as outlined above.

By signing below, I acknowledge that I am requesting to have my child’s therapy
sessions utilize MBTR+VC horses and program facilities. I agree to personally pay
the fee required to join the program and have access to program animals,
activities, and equipment during our therapy sessions. I am also requesting my
child’s therapist to carry out therapy sessions at this location. I understand that
Therapy Connections OT P.C., is billing insurance for therapy sessions completed in
accordance with therapy practice standards and is a separate entity from
MBTR+VC. I understand that I may at anytime choose to cancel our MBTR+VC
program membership and choose to complete my child’s therapy sessions at home
or in another community setting. I understand that if I have an unexcused absence
my barn fee will not be refunded. I agree with the attendance policies for therapy.