Vision Therapy Practice Builder Manual

 

First Therapy Session Paperwork  

 

 

Overview: 

 

This section includes a complete set of paperwork reviewed with the patient at their first VT session. We require that one parent be present for the first two sessions to ensure they understand the information presented and their role in the therapy program. None of this information should be new to them as it has been thoroughly reviewed during the Consultation appointment. See Homework Binder section for more information. 

 

 

Forms: 

 

1. HIPAA 

        This is a basic letter alerting new patients about HIPAA privacy laws and that our clinic abides by them when handling patient specific information. 

 

 

2. New Patient Information Guide

          This is a general information sheet for new patients that list our rules for coming in for a therapy session. This is the same sheet given at the consultation.

 

 

3. Classroom Suggestion List 

        This is a personalized list we prepare for each new patient. It outlines accommodations that teachers can do to ease the stress of schoolwork during their vision therapy program.  It also opens up an avenue for communication with the schools/teachers and can lead to additional in-services and speaking engagements. 

          

 

4. Home Therapy Agreement 

        This is the first document that the patient and/or parents sign regarding homework policies and expectations. It outlines the importance of home therapy, length of time of each home therapy session, expected feedback, parental involvement, etc.  This form is frequently brought up if any homework compliance issues come up later in the program. The white copy of this is sent home with the patient as well. There are additional Homework Warnings included in the VT Resources section. 

 

 

5. Program Guidelines (Regular & Office Copy) 

        This is the same from that they were given at the consultation. The therapist will review key points and have them sign both the office copy and a copy for them to keep. 

 

   

6. Early Exit Form 

        This is a basic form we have all new patients sign to alert them of a $50 administrative charge that is applied if they exit the program within the first 4 sessions. This cost covers the supplies and work time required to prepare a new patient file. This charge is applied to their first session if they return to therapy at a future date. 

 

 

  7.  Payment Forms

        These forms illustrate the way that we can manage our clinic with no accounts receivable – ever!