Practices and Policies:  Insurance Holders  (Kaiser and Meritage) 
 
Little Hands - Intake Form (Occupational Therapy)

Authorization of Practices and Policies: Insurance Holders (Kaiser and Meritage)

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Questions?

Gabrielle Perelmuter, MOT OTR/L
Clinical Director & Occupational Therapist

(415) 531-3027
gp@littlehandsot.com

Little Hands
500 Tamal Plaza, Suite 527
Corte Madera, CA 9492
littlehandsot.com

Practices & Policies: Insurance Policy Holders

NOTE:  Insurance policyholders are responsible for informing Little Hands of any change in coverage. Failure to do so will result in full charge for treatments.

 

I. ATTENDANCE POLICIES FOR EXCUSED ABSENCES

We require a 24-hour notification for cancellation due to illness.

Two-week notification is required for any non-illness absence.

 

II. VIOLATION OF ATTENDANCE POLICIES

If a child has 2 or more excused absences within a one-month period, your child may lose their scheduled appointment time.

If your child has ONE unexcused absence, they may lose their scheduled appointment time.

If a caregiver is 10 or more minutes late for pick-up, your child may lose their scheduled appointment time.

 

III. TERMINATION OF THERAPY

If you terminate therapy, for any reason, we require at least 2 weeks of sessions’ prior written notice in order for the therapist to transition the child out of therapy and complete closure. We reserve the right to terminate our relationship with a client at any time for any reason. Unless circumstances require otherwise, if we terminate the relationship, we will provide at least 2 sessions’ prior notice.

 

IV. PAYMENT

Payments are billed at the beginning of each month for upcoming sessions. A credit card is kept on file and only used for late payments or any unpaid dues.

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Questions?

Gabrielle Perelmuter, MOT OTR/L
Clinical Director & Occupational Therapist

(415) 531-3027
gp@littlehandsot.com

Little Hands
500 Tamal Plaza, Suite 527
Corte Madera, CA 9492
littlehandsot.com