Intake Form

Please set aside some time to complete this intake form.  The goal is to get a full picture of your child in the following areas:

• Medical History
• School Information
• Parent/ Guardian / Household Information
• Strengths & Areas of Concerns
• Your Goals for Treatment

*** You will need to upload the following documents on your computer or device to fully complete the form.***

• Pictures of the the front and back of your insurance card.
• Diagnostic Letter
• IEP (if you have one)