If you are a new client of InterPlay, please fill out the following forms prior to your first visit with us.
InterPlay is located in West Palm Beach and caters clients from all over Palm Beach county; from Wellington, Boca Raton, West Palm Beach, Jupiter, and more.
- Insurance Verification Form (If you filled out this form already, you do not have to do it again)
- Individual History Record (Please, make sure to complete all 5 pages)
- Information Release Form
- Insurance Information
- Notice of Privacy Act (HIPPA)
- Cancellation Policy
- Credit Card on File Agreement
- 2017-2018 Payment Policy
- Emergency Treatment Authorization
- Waiting Room Confidentiality Agreement
- Photo / Video Release Form
Completing ALL these forms BEFORE your first visit will ensure a fast intake on your apportionment day.
We are honored you chose us to be part of your child’s future!