UPDATE: TELEHEALTH SERVICES AND IN-CLINIC APPOINTMENTS – We are offering Telehealth Services for newly referred and existing clients and families at this time

We are also offering limited in-clinic appointments for clients at each of our locations.  Available appointments are based on scheduling criteria, capacity limits, and take into consideration building layout and continued safety for our clients and staff.

After reviewing details on getting started, here are the next steps in the process.

Completing and Returning Paperwork

Electronically: To complete paperwork electronically, please select from the options below to download the PDF file.  Save to your computer before entering your information in the fillable fields. Open the saved file using Adobe Acrobat Reader, complete forms, and email to:

(Please Note: In order to save your progress on a form, you must have an up-to-date version of Adobe Reader for your computer’s operating system).

By Mail or Fax: The links below can also be downloaded and printed to complete by hand. Completed packets can be:

  • Mailed ONLY to the Canby Clinic: 113 N Elm Street, Canby, OR 97013. 
  • Faxed to:
    • Fax# 503-266-8632 for Occupational, Physical, and Speech Therapy Services
    • Fax# 503-650-4302 for Mental Health and Medical Program Services

Paperwork Packets

Occupational, Physical, and Speech Therapy Services – Both packets need to be completed and returned, along with a written referral or prescription from the physician.   

Mental Health Services 

Medical Program Services 

Feeding Services

  • Feeding Services Packet – Needs to be completed IN ADDITION to the Neuro Registration and OT/PT/ST Supplemental Packets.

*Clients seeking occupational, physical, and/or speech therapy services, must also contact their doctor to send us a prescription for therapy services.

Billing Insurance

Insurance companies can help cover the cost of our services and, while we are not able to guarantee coverage, we are committed to helping you understand your plan’s benefits and assist in utilizing the existing benefits available. We are in-network with many commercial and state insurance plans and do bill for services provided at our clinics, even if we are out-of-network.

If we are billing insurance, it will be helpful for you to contact your insurance company for benefit and coverage information.  Our billing office will also contact your insurance company to verify benefits for your plan. This is not a guarantee of coverage, but will give us helpful coverage information.  More information about the initial evaluation and answers to frequently asked question can be found here.

Scheduling the Initial Evaluation Appointment

Once we receive your completed paperwork packet, our scheduler will contact you to schedule the initial evaluation.  On the day of your evaluation appointment, check in is 15 minutes before your scheduled appointment time.  Bring your insurance card so we can take a copy and bring any other relevant reports such as recent therapy evaluations, IEP/IFSP, diagnostic or psychological evaluations.

**Having trouble viewing or downloading our PDF files?  You may need to download a newer version of Adobe Reader.**