PARENT CORNER

New Patient Forms

Please download the form, fill in the form on your computer and email it back to us at citykidsfun.play.learn@gmail.com

If you have any questions, feel free to contact us at (773) 467-5669 or citykidsfun.play.learn@gmail.com

PATIENT DATA BASE

This form is to provide the office with names and addresses, physicians and basic patient information for our data base.
 

NEW CLIENT INFORMATION

This form is for the evaluating therapist to have basic information about the child’s history and current function. 

AUTHORIZATION of RELEASE 

This form allows City Kids to communicate with insurance companies and physicians regarding the client’s intervention.

Videotape/Photo
/Social Media Release

This form allows or disallows permission to use photos for social media, education and celebration of each child.

ATTENDANCE POLICY AGREEMENT FORM

This form explains attendance expectations and charges for missed appointments.

 

PATIENT PORTAL

Patient Portal Access

When your appointment is set up. A welcoming letter will be sent to your email with a temp password, your email is the username.

  1. Reset your password and access your patient portal..

  2. You can save this link or come back to the “For Parents,” section in our website.

Password Reset

There are two options to regain access to your portal:

  1. Use the generic password reset route in Raintree.

  2. Ask front office to reset it for you.