Call Us: (410) 970-2400

Forms and Paperwork

If you have any questions or concerns about your paperwork, please call us at (410) 970-2400. All forms below are PDFs, and must be downloaded and completed electronically or by printing and filling them out. Please make sure you fill out the forms with as much accurate information as you can.

Completed forms can be faxed to (410) 774-4090 or emailed to info@unbridledrehab.com. Thank you!

If you are looking for clinical services including physical, occupational or speech therapy, please print and complete the below packet.

2018 NEW CLIENT FORMS

For those looking to incorporate equine-assisted therapies (hippotherapy or unmounted activities with horses) into your treatment plan, you need to complete the packet for the specific center you will be receiving services at.

(Currently down due to being revised, contact the office if you need them)

For current clients or recent returning client who need to complete an update form, please print and complete the below packet.

 2018 UPDATE FORMS

Note: The medical history/physician referral form must be completed and signed by the referring physician PRIOR to your first visit. If you wish to go through your insurance for payment of services, you must also have a separate script for the type of therapy to be received (ie PT/OT/SPEECH, “Evaluate & Treat”) as required by most insurance companies for proper reimbursement of services.

Please take the time to review our HIPAA Compliance Policy & Notice.

Hippotherapy Start of Term

Every client participating in an integrated treatment plan (ITP) is asked to complete a start of term questionnaire a few weeks prior to break so we can better serve you.  Download and complete the form here.