DSC Therapy Pre-registration Form
Thank you for your interest in DSC therapy services! Please complete the following pre-registration form. DSC staff will build the tentative semester 1 schedule based on responses on this form. DSC staff will reach out to you about next steps, including a tentative session time/day, as well as formal registration steps. Completing this form expresses interest in therapy/skill building but does not confirm availability for services at DSC. 

Course dates:
-Weekday clients: There are 15 sessions total in Semester 2. Specific weeks for sessions (excluding makeup weeks) include the weeks of: 2/23, 3/2, 3/9, 3/16, 3/23, 3/30, 4/13, 4/20, 4/27, 5/4, 5/11, 5/18, 5/26, 6/1, 6/8
-Saturday clients: There are 9 sessions total in Semester 2. Specific dates for sessions include: 2/28, 3/14, 3/21, 4/4, 4/18, 5/2, 5/16, 5/30, 6/13

Please note that the description and fee structure for therapy services have changed: 
DSC Therapy Services: One-on-one (one instructor to one learner) therapy for individuals with Down syndrome for all ages (birth through adulthood). Occupational therapy and speech/communication therapy may both be available, depending on the age of the client. Clients may register for one therapy option, or both, and DSC will try to accommodate back-to-back sessions to the best of our ability. Sessions are 45 minutes in duration, once weekly, and occur at the DSC campus in Seattle. The cost for services follows a sliding scale based on annual household income. DSC is an out-of-network provider and does not directly bill insurance. However, for therapy services, a once monthly superbill can be produced for families seeking reimbursement from their insurance carrier. Scholarships can also be requested and are awarded if cost is a barrier to access. Please see the website for more details: https://www.dscpugetsound.org/therapy-services
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Email *
Do you understand that DSC now offers 1:1 services that accept DDCS Life Skills funds for ages 4+ years in the Skill Building program? If interested in using DDCS funds, please see "Skill Building" program and complete pre-registration there (NOT here) *
Parent/guardian name *
Client's name
Parent phone number *
Does the client have a Down syndrome diagnosis?
Clear selection
Age of client
Has the client received services at DSC before?
Clear selection
Please review the description:

Therapy Services: One-on-one (one instructor to one learner) therapy for individuals with Down syndrome for all ages (birth through adulthood). Occupational therapy and speech/communication therapy may both be available, depending on the age of the client. Clients may register for one therapy option, or both, and DSC will try to accommodate back-to-back sessions to the best of our ability. Sessions are 45 minutes in duration, once weekly, and occur at the DSC campus in Seattle. The cost for services follows a sliding scale based on annual household income. DSC is an out-of-network provider and does not directly bill insurance. However, for therapy services only, a once monthly superbill can be produced for families seeking reimbursement from their insurance carrier, who are paying DSC's standard rate of $70 per session. Scholarships can also be requested and are awarded if cost is a barrier to access. Please see the website for more details: https://www.dscpugetsound.org/therapy-services
 *
If follow-up was requested, please summarize your questions 
Which therapy is being requested? Speech/communication therapy is available for all ages, and occupational therapy is available for individuals ages 6+ years *
Required
What is the funding source that the client plans to use for services? *
If you are private paying, DSC now uses a sliding scale for fees. Please review: 

Annual Household Income & Price Per Session:

Below $40,000: $20 per session ($300 per semester for weekday, $180 for select Saturdays)

$40,000 - $69,999: $30 per session ($450 per semester for weekday, $270 for select Saturdays)

$70,000 - $99,999: $40 per session ($600 per semester for weekday, $360 for select Saturdays)

$100,000 - $149,999: $60 per session ($900 per semester for weekday, $540 for select Saturdays)

$150,000 and up: $70 per session ($1,050 per semester for weekday, $630 for select Saturdays)

Based on your annual household income, what is your per session cost? 

Clear selection
Would you like a superbill produced monthly? Note- only available for therapy clients paying DSC's standard rate of $70 per session
Clear selection
If private paying, do you require a payment plan?
Clear selection
If you are seeking potential reimbursement from your insurance carrier (and seeking a superbill), referral from the client's primary care physician is necessary. You will request services for the timeframe in which the client will be receiving services. Do you understand that a referral is needed and must be provided to DSC before services can begin?  *
If you selected speech/communication therapy, what goal(s) is the client hoping to address in therapy sessions? 
If you selected occupational therapy, what goal(s) is the client hoping to address in therapy sessions? 
What day(s) of the week is the client available for session(s)
*Please check all day(s) that the client is available
 *
Required
Please state specific availability on the day(s) selected above. For example, specific time frames available.  *
DSC therapy services have changed to a semesterly system. Semester 1 dates are 9/22/25 through 2/6/26. There are 15 weeks of sessions total. Do you understand that the dates are different for 2025-26 compared to previous years? *
Any other details you would like us to know or consider?
Submit
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