First Therapy Session Paperwork
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.
This is a basic letter alerting new
patients about HIPAA privacy laws and that our clinic abides by them when handling patient specific
2. New Patient
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
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
4. Home Therapy
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
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!