Therapists and families use this 3-page request to get At Home Program funding for out-of-school one-to-one occupational therapy, physiotherapy, speech-language pathology, chiropractic or massage for an enrolled child aged 5 or older. A physician or nurse practitioner is involved only for massage or chiropractic referrals and post-surgical rehabilitation letters. Written approval must arrive before services start.
The treating therapist completes most parts with the family, including service details, functional outcomes, coordination with the school or community team, and the therapist's signature. A physician or nurse practitioner signs Part 4 only for massage or chiropractic requests, and post-surgical requests need a letter from the physician, surgeon or nurse practitioner.
Download the current version from the source each time; forms change without notice.
At Home Program School-Aged Extended Therapies Request
Upload the fillable PDF once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms change without notice, so download the current version from the official page before you fill it in.
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Only for massage or chiropractic requests: Part 4, the Physician or Nurse Practitioner's Referral, states support for the massage or chiropractic service and carries the clinician's name, signature and date. For post-surgical rehabilitation in any discipline, the request also needs a letter from the physician, surgeon or nurse practitioner and the surgery date.
BC says children receiving School-Aged Extended Therapy funding transition to the new Disability Benefit starting April 2026 and that affected families will be contacted. New families can still apply until March 2027. At Home Program Medical Benefits, such as supplies and equipment, are not affected by this change.
No. The form states that written approval from the At Home Program must be received before the requested service is delivered. All parts must be completed to avoid delays, and the therapist named in Part 7 must match the payee name on future invoices when payment goes to the therapist.