Please visit the request an evaluation page on our website.

Complete and we will be in contact when we can schedule services.

You may follow up at any time on referrals submitted.

Before getting started with direct services our company requires the completion of this intake packet of consent forms.  Please complete and then press submit and we will add these forms to your child's file.

Having a new facility is wonderful but there are some general policies and releases that we need to make sure that we share prior to your first session with us.  Please complete these forms for updated records. 

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If you have concerns regarding your child's feeding and/or swallowing skills please complete this form to provide further information about your child's experience with eating.  Most often your child's treating therapist will direct you to this form if it is needed to be completed; however, if you want to be proactive and complete this if you have concern we greatly appreciate it and will share the form with your child's therapist. 

If you are requiring services but do not have an insurance that we are able to accept - Please complete the private pay consent form.

We would need this one file prior to services being rendered.

Before getting started with services please complete this case history form to help us get to know more about your child and how we can best support you and your family.

Please complete to allow us to know in what ways we can or

cannot capture moments in therapy with your loved one. 

Our heart is to highlight our values, the joy of what we do and the littles we have the opportunity to serve.  If you ever want to change your mind about how we are allowed to use these images/videos you can complete this form again and we will always implement the most recent form that we have on file for your child. 

Please consider completing to help Communication 

Cottage Therapy, LLC always ensure that we are actively seeking out our community's input as to what we are currently doing and what we are hoping to offer in regards to Pediatric Therapy Services and supportive programming. 

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