Therapy Authorization Forms

Please complete and fax the form to the number specified. Registered users of Landmark Connect may complete and submit forms electronically. Specific forms for each therapy and instructions for completing the form are provided.

Forms and Instructions

• Chiropractic Treatment Plan Form
  - form Instructions

• Speech Therapy Form
  - form Instructions

• Physical Therapy Form
  - form Instructions

• Occupational Therapy Form
  - form Instructions

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