Client Forms | Blossom Therapeutics

New Blossom Clients - Personal History

As a parent of a child working with a Blossom therapist, you will fill out this form when you bring your child for the initial evaluation. Fill it out in advance to save time! The form is an in depth view into developmental history of the child, and current everyday functioning in daily life. This form provides our OT’s with a more global look at your child through your eyes.

Consents/HIPPA

Privacy act is required by anyone in the medical or health field to provide to their clients with their rights in a relationship with a healthcare provider. The form insures that your information will not be shared outside of the clinic without their authorization.

Release and HIPPA Consent

This standard medical form is required for any medical office. It releases the Blossom practice from responsibility in the event of accidental injury that may occur due the physical nature of our work.

We're Here To Help

Visit Us

211 NE Revere Ave

Bend, OR 97701

(Located in the Blockbuster building)

Questions?

Feel free to call or email us with any questions you may have. We look forward to hearing from you.

Office: 541-617-8769

Fax: 541-668-6772

info@blossomtherapeutics.com

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