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info@seattlethera.com

206-322-5433

  • Services
    • Occupational Therapy
    • Speech and Language Therapy
    • Feeding Therapy
    • AAC
    • Teens/Young Adults
    • Teletherapy
    • Schools
  • About Us
  • Client Center
  • Articles
Menu
  • Services
    • Occupational Therapy
    • Speech and Language Therapy
    • Feeding Therapy
    • AAC
    • Teens/Young Adults
    • Teletherapy
    • Schools
  • About Us
  • Client Center
  • Articles

Thank you for Payment

Location

2815 Eastlake Ave E Suite 200, Seattle

Call Us

206-322-5433
FAX: 206-322-7545

Email

info@seattlethera.com

ABOUT US

We hold the belief that hope begins with feeling understood.

That belief fuels a family-centered therapy process that identifies the specific needs of each child, and tailors a therapy plan that celebrates that child’s successes and acts as a
catalyst for his/her growth.

Understanding an individual’s specific abilities allows us to maximize his/her potential, rather than manage limitations.

Our site uses cookies. By continuing to use our site, you are agreeing to our Cookie Policy.

MENU

  • Services
    • Occupational Therapy
    • Speech and Language Therapy
    • Feeding Therapy
    • AAC
    • Teens/Young Adults
    • Teletherapy
    • Schools
  • About Us
  • Client Center
  • Articles
  • Services
    • Occupational Therapy
    • Speech and Language Therapy
    • Feeding Therapy
    • AAC
    • Teens/Young Adults
    • Teletherapy
    • Schools
  • About Us
  • Client Center
  • Articles

SOCIAL

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Intake Form - Teen/Young Adult

  • Client Information

    Please complete the information in the forms about the patient and we'll get back to you for an appointment.
  • MM slash DD slash YYYY
  • Parent/Guardian Name

  • Additional Parent/Guardian Name

  • Financial Policy & Agreement

  • Our mission is building skills for life by providing patient care that maximizes outcomes and brings people and environments together. This is different than having a goal to fit into an insurance reimbursement model. We have made the choice to not contract with insurance because we strive to provide wrap-around therapeutic services to our clients. The level of care we provide is sometimes incongruent with insurance reimbursement because of the limited nature of what they consider therapeutic. We understand that choosing a therapy provider is an important one for every individual. We provide invoices with billing/CPT codes – when appropriate – to match the services we’re offering.

    All therapy fees are based on 50-minute appointments unless otherwise stated.

    Occupational Therapy

    OT Intervention or Consultation: $155.00 (clinic/telehealth) - $235.40 (community*)

    OT Evaluation (2 hours): $630.00 - $700.00

    OT Evaluation (1-1.5 hours): $367.50 - $517.50

    OT Re-evaluation (1.5-2 hours): $517.50 - $700.00

    OT Initial Community Visit*: $342.40

    OT Clinical Treatment Planning/Continuity of Care: $38.50 per 15 minutes

    Speech-Language Therapy

    SLP Intervention or Consultation: $153.00 (clinic/telehealth) - $230.00 (community*)

    AAC Intervention or Consultation: $40.00 per 15 minutes

    SLP Evaluation or AAC Evaluation (2 hours): $630.00 - $750.00

    SLP Evaluation (1-1.5 hours): $367.50 - $517.50

    SLP Re-evaluation (1.5-2 hours): $517.50 - $700.00

    SLP Initial Community Visit*: $342.40

    Clinical Treatment Planning/Continuity of Care: $38.50 per 15 minutes

    Feeding Therapy

    Initial Feeding Consultation: $229.00

    Multidisciplinary Feeding Evaluation: $400.00-$700.00

    Feeding Therapy (SLP or OT): $162.00 (clinic/telehealth) - $235.40 (community*

    Feeding Clinical Treatment Planning/Continuity of Care: $40.50 per 15 minutes

    Travel: Most travel costs within Seattle are included in community-based fees. $36.00 per 15 minutes is applicable for travel that exceeds 15 minutes.

    Co-treatment: when two or more therapies occur during the same 50-minute session. This is provided when it is clinically beneficial to a client’s care. When co-treatment sessions are provided, all disciplines hourly rates apply as they are each providing skilled intervention working towards treatment goals.

    Payment: Payment for initial service and evaluation/s are due at the time of service. Payment for additional therapy services is due at the end of each month. Invoices are emailed from Fusion. At least 24 hours’ notice is required for any appointment cancellation to avoid the full fee for the scheduled service (some exceptions apply). No shows are billed the full fee.

    Invoices: Seattle Therapy – Skills for Life does not submit invoices directly to medical insurance companies, nor does Seattle Therapy - Skills for Life accept payment from them. We provide detailed invoices, with itemized billing codes when applicable. Preauthorization for services may be required prior to submitting claims to insurance carriers. The client or the parent/guardian is responsible for obtaining preauthorization

    I, the client, or parent/legal guardian, understand that I am responsible for all charges for services provided to me or my child by Seattle Therapy – Skills for Life. I am aware that Seattle Therapy – Skills for Life does not contract with any insurance carriers. I have been notified that it is my responsibility to contact my insurance carrier to determine whether the services by Seattle Therapy – Skills for Life meet the reimbursement criteria and whether preauthorization is required.

    I agree to pay Seattle Therapy – Skills for Life for evaluation fees at the time of service. I agree to pay Seattle Therapy - Skills for Life for additional services at the end of each month for services rendered that month. There will be a 20% fee for returned checks or those with non-sufficient funds. There will be a 10% late fee for accounts 45 days overdue. Accounts that are 90 days overdue may be referred to a collection agency and incur a 30% administrative charge and interest on the late payment.

    Your signature below verifies that you have read this two-page document and agree to the terms. If any part of this form is unclear, please consult with Seattle Therapy – Skills for Life prior to providing your signature.

  • I, The Parent/ Legal Guardian or Patient, understand that:
  • I, the Parent/ Guardian or Patient, have been notified that:
  • MM slash DD slash YYYY
  • Reset signature Signature locked. Reset to sign again

Intake Form - Pediatric

  • Client Information

    Please complete the information in the forms about the patient and we'll get back to you for an appointment.
  • MM slash DD slash YYYY
  • Parent/Guardian Name

  • Additional Parent/Guardian Name

  • Financial Policy & Agreement

  • Our mission is building skills for life by providing patient care that maximizes outcomes and brings people and environments together. This is different than having a goal to fit into an insurance reimbursement model. We have made the choice to not contract with insurance because we strive to provide wrap-around therapeutic services to our clients. The level of care we provide is sometimes incongruent with insurance reimbursement because of the limited nature of what they consider therapeutic. We understand that choosing a therapy provider is an important one for every family. We provide invoices with billing/CPT codes – when appropriate – to match the services we’re offering.

    All therapy fees are based on 50-minute appointments unless otherwise stated.

    Occupational Therapy

    OT Intervention or Consultation: $155.00 (clinic/telehealth) - $235.40 (community*)

    OT Evaluation (2 hours): $630.00 - $700.00

    OT Evaluation (1-1.5 hours): $367.50 - $517.50

    OT Re-evaluation (1.5-2 hours): $517.50 - $700.00

    OT Initial School Visit*: $342.40

    OT Clinical Treatment Planning/Continuity of Care: $38.50 per 15 minutes

    Speech-Language Therapy

    SLP Intervention or Consultation: $153.00 (clinic/telehealth) - $230.00 (community*)

    AAC Intervention or Consultation: $40.00 per 15 minutes

    SLP Evaluation or AAC Evaluation (2 hours): $630.00 - $750.00

    SLP Evaluation (1-1.5 hours): $367.50 - $517.50

    SLP Re-evaluation (1.5-2 hours): $517.50 - $700.00

    SLP Initial School Visit*: $342.40

    Clinical Treatment Planning/Continuity of Care: $38.50 per 15 minutes

    Feeding Therapy

    Initial Feeding Consultation: $229.00

    Multidisciplinary Feeding Evaluation: $400.00-$700.00

    Feeding Therapy (SLP or OT): $162.00 (clinic/telehealth) - $235.40 (community*)

    Feeding Clinical Treatment Planning/Continuity of Care: $40.50 per 15 minutes

    Travel: Most travel costs within Seattle are included in community-based fees. $36.00 per 15 minutes is applicable for travel that exceeds 15 minutes.

    Co-treatment: when two or more therapies occur during the same 50-minute session. This is provided when it is clinically beneficial to a client’s care. When co-treatment sessions are provided, all disciplines hourly rates apply as they are each providing skilled intervention working towards treatment goals.

    Payment: Payment for initial service and evaluation/s are due at the time of service. Payment for additional therapy services is due at the end of each month.

    Invoices are emailed from Fusion. At least 24 hours’ notice is required for any appointment cancellation to avoid the full fee for the scheduled service (some exceptions apply). No shows are billed the full fee.

    Invoices: Seattle Therapy – Skills for Life does not submit invoices directly to medical insurance companies, nor does Seattle Therapy - Skills for Life accept payment from them. We provide detailed invoices, with itemized billing codes when applicable. Preauthorization for services may be required prior to submitting claims to insurance carriers. The client or the parent/guardian is responsible for obtaining preauthorization

    I, the client, or parent/legal guardian, understand that I am responsible for all charges for services provided to me or my child by Seattle Therapy – Skills for Life. I am aware that Seattle Therapy – Skills for Life does not contract with any insurance carriers. I have been notified that it is my responsibility to contact my insurance carrier to determine whether the services by Seattle Therapy – Skills for Life meet the reimbursement criteria and whether preauthorization is required.

    I agree to pay Seattle Therapy – Skills for Life for evaluation fees at the time of service. I agree to pay Seattle Therapy - Skills for Life for additional services at the end of each month for services rendered that month. There will be a 20% fee for returned checks or those with non-sufficient funds. There will be a 10% late fee for accounts 45 days overdue. Accounts that are 90 days overdue may be referred to a collection agency and incur a 30% administrative charge and interest on the late payment.

    Your signature below verifies that you have read this two-page document and agree to the terms. If any part of this form is unclear, please consult with Seattle Therapy – Skills for Life prior to providing your signature.

  • I, The Parent/ Legal Guardian or Patient, understand that:
  • I, the Parent/ Guardian or Patient, have been notified that:
  • MM slash DD slash YYYY
  • Reset signature Signature locked. Reset to sign again
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