Please note that if you have a current prescription from your doctor for physical therapy, occupational therapy, or speech therapy already, you can proceed with this form. If you are a new rehabilitation patient and you have not received a prescription from your physician, you will need to do that prior to filling out this form. In addition, new patients are encouraged to come in for an in-person evaluation and then, if appropriate, the therapist can make telehealth part of your treatment plan to limit the amount of follow up visits needed in the clinic.