Request for Occupational Therapy/Physical Therapy Consultation

This form must be used to request an initial occupational and/or physical therapy consultation.  The Special Education teacher or other involved individual will provide all the information requested on the form.  There must be a signature providing parent permission prior to mailing this form to the Cooperative office.  Once received by the Cooperative office, the form will be sent to the appropriate service provider.  This form is not to be used for regularly scheduled follow-up visits/updates.
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Bridget Gauthier,
Oct 9, 2013, 1:04 PM