Tricare Prime Patients

Please note that we bill directly to Tricare Prime only when a medical order / or referral has been provided.

If you have a civilian doctor on the military base  – here is the reference to write on the Occupational Therapy prescription:

Occupational Therapy: For emotional dys-regulation – impacting daily functioning

Below fill out the following linked on the buttons below:

1. Pediatric Intake Form
This series of forms gets patient, insurance and family information as well as explains payment procedures and policies.

2. Medical History Form
Clinical packet that will ask more clinical focused questions and health history.

3. Sensory Profile
that will help us to learn more about the child’s individual profile and how he/she deals with activities of daily living.

4. Bayley 4 Assessment
That will help us to understand more about child current emotional and behavioral situation.

5. Parent Stress Index (to complete one copy for each parent)

6. Romif

7. SOF

Please fill out the online forms. Print any PDF forms, complete, and scan them back to contact@militaryhealthcareoverseas.com with the doctor prescription.