Required Forms – Sprout Center

REQUIRED FORMS

Access The Forms You Need

Before participating and on an annual basis, individuals need to consult with their physician about participation at Sprout. PATH Intl. Centers require each prospective participant to present a complete medical history and a signed physician’s statement prior to any delivery of services.

Forms can be sent to Sprout in the following ways:

Mail To: Sprout Center, P.O. Box 8, Aldie, VA 20105

Fax To: (571) 668-4470

E-Mail To: office@sproutcenter.org

Click the Form Name to Download:

– Physician Release – ALL Therapeutic/Adaptive Riders AND Hippotherapy Clients When Starting at Sprout

– Physician Annual Update – For ALL Therapeutic/Adaptive Riders AND Hippotherapy Clients Completed Before the Program Year

– AAI Form – For riders with a diagnosis of Down Syndrome

– Seizure Form – For riders who experience Seizures

– Therapy Orders – For riders in Physical or Occupational Therapy

– Release of Information From Outside Providers

– Committee Interest Form

If you’ve been a part of Sprout, THANK YOU!
If you are new to Sprout, please come visit and see our work in action!

"Sprout is a place where victories, both large and small, are celebrated... because victory is amazingly significant to someone who struggles daily."

Physical Address:
40685 Little River Turn Pike Aldie, VA 20105

Mailing Address: P.O. Box 8 Aldie, VA 20105

info@sproutcenter.org

Newsletter:

Phone: (571) 367-4555
Fax: (571) 668-4470