Summer 15 week Group Therapy

Thanks for showing interest in our therapy groups! We are very excited to offer a variety of groups that target sensory processing and pragmatic skills. Summer groups begin on May 7th  and meet once a week for 15 weeks. Group placement is dependent on the child’s skill level. It is required that each child must participate in an evaluation and we must be provided with a current doctor’s prescription prior to being placed into a group to ensure the best fit.

Listed below are all of the groups that we will be offering this summer. In order to participate in the 2012 summer group, an initial evaluation must be completed by April 26th. Group registration forms for current clients who have already participated in an initial group evaluation are due no later than April 19th. Please contact us for additional information.  

Pragmatic Groups (billing code 92508)

1. Target improving engagement in social settings, conversation skills, repairing communication breakdowns, maintaining eye contact, listening to and following directions, and turn-taking
2. Utilize role-play, social stories, scripts, and social thinking
3. Led by a speech therapist

Sensory-Based Pragmatic Groups (billing code 97150 and 92508)

1. Utilize sensory strategies to enhance social interaction
2. Led by an occupational therapist and a speech therapist

 Therapy Group Registration Form

Summer 15 Week Group

Session Dates:

May 7th through the week of August 13th  

Child’s Name:_________________________________________________________________

Child’s Date of Birth:_______________________________________ Age: _______________

Parents Name: ______________________________________

Home Address: _____________________________________

Family E-mail: __________________________________________

Home Phone Number: ____________________________________

Cell Phone Number: _____________________________________

Other Specialist/Therapy Received: ________________________________________________

_____________________________________________________________________________

Date of Last Evaluation: _________________________________________________________

Allergies or Medical Needs: ______________________________________________________

_____________________________________________________________________________

Parental Concerns: ______________________________________________________________

_____________________________________________________________________________

Goals:_____________________________________________________________________________________________________________________________________________________

Other: ________________________________________________________________________

_____________________________________________________________________________

______________________________________________________________________________

Please circle which group you are interested in:

Pragmatic Group (billing code 92508)

1. Ages 8-11 Monday 5:00 pm            

Sensory-Based Pragmatic Group (billing code 97150 and 92508)  

1. Ages 4-8 Tuesday 4:00 pm    

Method of Payment (Please check one):

The group billing codes are 97150 for occupational therapy group and 92508 for speech therapy group. Please consult your insurance company with the appropriate billing codes to determine if group therapy is covered, since it is often not a covered service.  If insurance will be covering the billing codes your insurance will be billed at the end of the session.  An administrative discounted rate is offered to families paying in full in advance and assuming responsibility for insurance reimbursement.  The full amount will be charged even if every session is not attended. Please refer to the attached group rates form for the cost of sessions depending on the length and method of payment.  

□ I’d like to take advantage of the administrative discount rate.  Payment is accepted in cash, check, or credit card. Payment is due in full no later than May 7, 2012.  

□ I’d like Kids Can Do, Inc. to bill my insurance.  

Parent/Guardian Signature:_________________________________