| Document Date: 2015-03-24 16:58:03
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Company MasterCard / / Currency USD / / Facility Pediatric Therapy Center / / IndustryTerm insurance benefits / insurance coverage / insurance information / health insurance coverage / change insurance plans / non-food / therapy services / insurance co-payment / insurance claims / insurance plan / insurance card / insurance carrier / insurance / food / / Organization Pediatric Therapy Center / Date ***TO BE SIGNED IN OFFICE / US Federal Reserve / / Position General Information Child / General / legal custodian / / Technology cellular telephone / MRI / /
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Welcome to Pediatric Therapy Center, PC! We appreciate the opportunity to work with you and your child. Please read through and complete all paperwork before your arrival. We ask that you please arrive 15 minutes prior t