Keri Skipper, MCD CCC-SLP
Phone: 864-406-6769
Email: [email protected]
Web: pathwayspediatrictherapysc.com
Company Policy/ Cancellation and Sick Policy
Please initial each line:
______I understand that a legal adult (18 yrs. +) will be present during therapy sessions.
______I understand if my child becomes ill, I should cancel therapy until my child has remained fever-
free and/or symptom free for at least 24 hours. Symptoms include: diarrhea, throwing up, rashes, strep
throat (must be on antibiotics for at least 24 hours), and severe cold/flu symptoms.
______I understand in the event I must cancel a therapy session, I should contact my child’s therapist at
least 24 hours prior to the session.
______I understand that Pathways Pediatric Therapy, LLC may discontinue services when 2 sessions are
missed without prior notification (no shows).
______ I understand continuity of care is priority and excessive cancellations may result in Pathways
Pediatric Therapy, LLC discontinuing services. This will be determined at the discretion of the owner.
______I understand my child’s therapist will offer to make up therapy sessions, cancelled by either
parties, given schedule availability.
Patient Name: __________________________________________________________
Parent or Legal Representative Signature: ____________________________________
Date: ______________
Therapist Signature: _____________________________________________________
Date: ______________