Before treatment is initiated, the following forms must be completed. You may print these forms and bring them with you on your first visit or you may come in 15 minutes early to your scheduled session and fill out the paperwork at our facility.

Please feel free to contact us if you have any questions while filling out the forms!

Printable Forms: Please print ALL forms (forms appear in order below)

Children 0-21

Children’s Intake Packet

Children’s Intake Packet (Español)

Speech Therapy Addendum

Mental Health Adult Clients

Adult Intake Form 1 – General Info
Adult Intake Form 2 – Survey
Adult Intake Form 3 – Release
Adult Intake Form 4 – Notice of Privacy
Adult Intake Form 5 – Informed Consent
Adult Intake Form 6 – Cancellation Policy

 

Insurance Information

Insurance InfoChildren’s Therapy Solutions, Inc. accepts most major insurance providers, as well as Medicaid and private pay on a sliding scale basis.

Insurance providers we accept include:

  • BLUE CROSS/BLUE SHIELD
  • CMS
  • MANATEE CHOICE
  • UNITED HEALTH CARE
  • WELLCARE
    • STAYWELL
    • HEALTHEASE
    • FREEDOM FIRST
    • UNITED HEALTHCARE MPLUS PLANS
  •  MAGELLAN
  • AMERIGROUP
  • VALUE OPTIONS
  • TRI CARE (Mental Health Only)
  • EVOLUTIONS (Mental Health Only)
  • CIGNA (Mental Health Only)
  • AETNA
  • INTEGRAL
  • PRESTIGE
  • HUMANA (Mental Health Only)

If you are uninsured, please visit the following website to apply for financial assistance. Please feel free to contact us with any questions!

www.manateehope.com

 

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