Start Therapy/Forms

Please Complete The Following Steps To Successfully Initiate Services:

  1. Contact your insurance company to verify if there would be coverage for the services your child needs. Questions to ask include:

    • If there is coverage, are there any exclusions?
    • Do I have a neuro-developmental benefit?
    • Do I have a co-payment or is there a percentage of the bill I will be responsible for?
    • Does my plan require a deductible be paid for the calendar year before the coverage begins?
    • Does my insurance plan cover only a limited number of sessions for each calendar year?
    • Is there a requirement that I get a prior authorization and/or a referral/order from my physician before I see a clinician?

  2. Obtain order/referral from your child's physician if you haven't already.

  3. For Aquatic, Physical, Occupational &/or Speech Therapy, Feeding, Handwriting, and other, complete the appropriate forms below and email, fax or mail the forms back to MOSAIC Children's Therapy.

Note: Your intake forms and any other requested information must be received no later than one week before your scheduled appointment.

Available Forms: