|
 Kool
Kidz accepts referrals from a physician, from an Early Intervention
Coordinator, from another therapist or educator and from the family
itself.
To
get started, contact us via phone or email for any questions or
information and for available appointment times.
| We
do need some support information prior to our first visit. Listed
below is a checklist of the things we need from you. Forms needed
can be selected and printed by clicking on the linked form names below.
Once finished with the form, click your browsers "Back"
button to return here. |
|
To
access printable forms, you must have Adobe Acrobat Reader on
your computer. If you do not have the Acrobat software, click this
image to download. It is a free download but may take a while so be
patient. |
 |
Prescription from your child's primary care physician. |
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|
Current
physical therapy evaluation, less than 12 months old. We can perform
the evaluation; but, if another therapist has done a recent evaluation,
we're happy to accept it. |
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Kool
Kidz History Form |
|
Kool
Kidz Consent, Authorization
to Release Information, and Guarantee
of Account Forms |
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Insurance
information. Please copy the front and back of primary and any
secondary insurance. |
|
Medicaid
information, ie a copy of the current months eligibility form
(Traditional Medicaid, Georgia Better Health Care, Deeming Waiver,
or Peachcare for Kids). |
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Preauthorization.
Kool Kidz is currently able to bill your insurance for you. However,
if your insurance company requires preauthorization,
we do ask that you go through this process prior to beginning physical
therapy. |
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Current
IFSP (Individualized Family Service Plan) if ages 0 to 3 and participating
in the Georgia Babies Can't Wait Program. |
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Current
Physician Plan of Care if using medicaid as funding source and
not covered under an IFSP. Kool Kidz can assist in the preparation
of this document for your physician. |
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