Thank you for your interest in Green Hill Therapy. Our goal is to help children reach their full potential through proven, playful intervention. Before we can begin the scheduling process, we require the following to be completed:
- Request a physician’s order that states the following:
- PT and/or OT to Evaluate and Treat (do not specify hippotherapy or aquatherapy)
- Your child’s medical diagnosis, including ICD10 code
- Your child’s date of birth
- Provide legible copy of front and back of insurance card(s)
Return the order and insurance card to Green Hill Therapy, so that we can schedule an evaluation. Prior to your child’s scheduled evaluation, this intake packet must also be filled out completely. We strongly encourage you to return it to your office prior to your scheduled examination.
If you are unable to return the packet to our office in advance for any reason, you must arrive at least 30 minutes prior to your scheduled appointment to complete the paperwork in our waiting room to allow time for your child’s therapist to review the information. If you arrive without completed paperwork less than 30 minutes prior to your child’s scheduled evaluation, your appointment may be cancelled and you will need to request your evaluation for another time after your competed paperwork has been received. After your evaluation, we must get authorizations for ongoing visits from the insurance company. We will let you know when your next appointment is as it is not always the following week due to insurance process.
This registration form (under Intake Application on our website) can be completed on your computer and e-mailed back to us using Adobe.
Once completed, email, fax or mail back using the information below:
- EMAIL: firstname.lastname@example.org
- FAX: 502.244.6631
- MAIL or IN PERSON: Courtney Springer Office Billing Manager 1410 Long Run Rd Louisville, KY 40245