OT & Me
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Connect with us

Please reach out via phone or email if we can assist you in any way.
​You can also find us on Facebook and Pinterest.
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5821 Linglestown Road Suite 212
​Harrisburg, Pa 17112

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(717) 364-4360

Fax: 717-974-0545
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OTandMePa@gmail.com

Patient Portal

Free OT screening

 Fill out the form below if you would like to schedule a free phone screening regarding your child.
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Forms

Intake/ Demographic
File Size: 133 kb
File Type: pdf
Download File

Informed Consent
File Size: 166 kb
File Type: pdf
Download File

Notice of Privacy Practices
File Size: 312 kb
File Type: pdf
Download File

Receipt of HIPAA
File Size: 98 kb
File Type: pdf
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Cancellation Policy
File Size: 87 kb
File Type: pdf
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Release of Information
File Size: 105 kb
File Type: pdf
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Email Consent
File Size: 163 kb
File Type: pdf
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Consent to Bill Insurance
File Size: 116 kb
File Type: pdf
Download File

Insurance Questions
File Size: 153 kb
File Type: pdf
Download File

Caregiver Questionnaire
File Size: 162 kb
File Type: pdf
Download File

Phone:
​717.364.4360

Fax:
​717.974.4545
Email:
​OTandMePa@gmail.com
Facebook:
​www.facebook.com/otandmepa
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***Please note that our website does not depict actual clients' photos or names. At OT & Me, LLC, we feel it is our duty to protect the dignity of the children we serve and therefore do not use identifying information even with parent permission.
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  • Home
  • Who we are
  • What we offer
  • Our therapists
  • FAQ
  • Connect with us