How to Refer/Forms to Complete

KIDNETICS now requires physician orders for ALL therapies.  If you are a parent interested in services, please print out the following referral form and take it to your child's doctor for him/her to complete.  The doctor's office can then fax the form to our business office at (864) 331-1446, or you can return it along with the paperwork outlined below. 

Referral form:  kidnetics_referral_form.pdf  

For ALL evaluations, please print out and complete the registration and consent to treat forms below.  Also, review and sign our policies.

Registration form:  kidnetics_registration2.pdf

Consent to treat:  consent_to_treat.pdf

Policies:  kidnetics_policies.pdf

For a developmental assessment by occupational, physical, and/or speech therapy, please complete the parent questionnaire that corresponds to your child's age.

For birth-to-3 years:  parent_questionnaire_birth_to_3_years.pdf

For over 3 years:  parent_questionnaire_3_years.pdf

For an occupational therapy evaluation, please complete the following sensory and self-care questionnaires, in addition to the developmental parent questionnaire above.

OT sensory questionnaire:   ot_sensory_questionnaire.pdf

OT self-care questionnaire:  self_care_questionnaire.pdf  

For a feeding evaluation, if you have not been contacted by our business office, please complete the feeding clinic referral form that corresponds to your child's age.  Also, complete the parent questionnaire (above), along with the feeding specific questionnaire (below), both that correspond with your child's age.

      Referral form for 2-10 months:  feeding_clinic_referral_form_2_10_months.pdf

      Referral form for 10-18 months:  feeding_clinic_referral_form_ages_10_18_months.pdf

      Referral form for over 18 months:  feeding_clinic_referral_form_over_18_months.pdf

      Feeding pages for under 6 months:  infant_feeding_questionnaire_under_6_months.pdf

      Feeding pages for over 6 months:  feeding_questionnaire_over_6_months.pdf

 

** If you are uncertain which forms to complete, please contact the KIDNETICS business office at (864) 331-1350.