Southland Paperwork:

Intake paperwork/ patient screening forms: Once all of the appropriate referral information is received we can assign the best therapist(s) to your child. The therapist(s) will call you to set up your child’s first appointment. Before your evaluation please complete the following forms, the information from these forms is necessary for the therapists to complete your child’s evaluation. Please be as thorough as possible.

** If you have not begun the process to become an established patient with Southland Therapy Services, please call our office at 912-335-1650 to self refer or contact your child's pediatrician/ medical provider **

Click here to learn more about the referral process and what is needed to get services started.

NEW PATIENT SCREENER FORMS:

- Patient Screener Form (English)

- Patient Screener Form (Spanish):

NEW PATIENT INTAKE FORMS:

- Intake Form (English):

- Intake Form (Spanish):

- Media & Photo Release Form

STUDENT & EDUCATION FORMS:

- Student Observation Request Form

- Student Feedback Form

- Southland Student Terms & Conditions

PHYSICIAN REFERRAL FORMS:

- Southland Referral Form - GA

- Southland Referral Form - SC

SC THERAPIST FORMS:

- SC Parent Signature Form

- SC COVID19 Sick Policy

- SC Consent For Telehealth