HIPAA- Vaccination Policy

  • Please select your correct location for each form.
  • Statement of Intent: Pediatric Therapy Services, Inc. expects all patients to be vaccinated.

    Immunizing patients against preventable diseases is a critical component of high quality medical care. In order to provide excellent care and a safe medical home for all patients, Pediatric Therapy Services is establishing a vaccination minimum standard.


    All Pediatric Therapy Services patients should be vaccinated according to the American Academy of Pediatrics endorsed vaccine schedule.

    Existing patients who are not currently being vaccinated according to the AAP schedule will be dismissed from our practice.

    New patients who are not adhering to the minimum vaccine schedule according to the AAP will not be permitted to begin treatment at PTS.

    If patients cannot commit to this minimum vaccination standard, then Pediatric Therapy Services, Inc. will no longer be able to commit to being their pediatric therapy provider.

    Once a patient notifies PTS of their decision to refuse vaccination according to the minimum standard, PTS will initiate the process necessary to smoothly transition the patient to another practice.

    I understand that I am responsible for notifying Pediatric Therapy Services, Inc. of any changes in my vaccination schedule.
  • My signature below indicates that I am the legal guardian of this patient and that I understand and accept this policy.