Pediatric Skill Builders

Occupational and Physical Therapy Services in Orlando, Florida

Child holding paint brushes

Policies and Agreements Form

Note: Patients with Medicaid coverage will not be billed upfront for services.

By signing this document, you are stating that you have read and agree to the terms listed above.

To be signed by the patient or primary guardian of patient:
Today's Date

Instructions

Please fill out each field if possible and click "Submit". If you have any difficulty, please contact us at (407) 389-4357.