ADMISSION FORMS

Ready to schedule your first appointment?

Please click on the link below to be redirected to our new patient information and insurance page. If you have already scheduled your first appointment and would like to complete our admissions forms prior to your appointment, scroll down this page to find correct admissions forms that are specific to the service your child is scheduled for.

For Occupational, Physical and Speech Therapy Services

Please click on the General Admissions Form link below and fill out the online form which will be automatically submitted to us.

PLEASE READ – Please review our updated attendance policy click here.

For Audiology Services

Please click on the Audiology Admissions Form below for the corresponding age group of your child and you will be able to fill it out online. Once submitted, we will contact you to schedule your appointment.

For Current Patients of Beyond Limits

Please click on the Current Patients Form link below and fill out the online form which will be automatically submitted to us.

Telehealth Consent Form

Use this form to obtain your consent to participate in a telehealth consultation in connection with the following procedure (s) and/or services (s):

Occupational Therapy, Physical Therapy and/or Speech Therapy.

PAYMENT CONSENT FORM

This form is to obtain your consent to securely store your preferred method of payment for your child’s health appointments. By signing this consent form, you authorize Beyond Limits Pediatric Therapy Center to charge your card at the time of your child’s weekly appointments.

AUTHORIZATION FOR REQUEST OF MEDICAL RECORDS

Need an Authorization for Request of Medical Records or Disclosure of Protected Health Information to Third Parties?

Please click on the link below for an authorization form.

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