Forms

New Patient Paperwork

At our Great and Small location, parents and caregivers need to sign and provide a copy of this Release Form.

For OT utilizing hippotherapy Great and Small requires this medical form to be filled out by your child’s doctor once per year. https://cultivaterehab.com/wp-content/uploads/2024/07/Medical-History-and-Physician-Statement-GS.pdf

For new patients referral form– a new referral is needed once a year.

We keep a credit card on file which we charge for payments that are more than 90 days past due. Credit Card Authorization Form.