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New Client Information

Please complete the following information. All information is considered confidential. Please allow 15-30 minutes to complete these forms, as you cannot save and come back.

*These fields are required.

  • Child's Case History

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  • Birth History:

  • Developmental Milestones

    At approximately what age did your child:
  • School

  • Therapies

  • Agreement to Terms of Payment

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  • Release of Information

    No information concerning the child or the evaluation results will be released unless the following form is signed by the parent or legal guardian. Signature is required for reports to be provided for anyone either than parent or legal guardian. Your initials represent your legal signature.
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  • Policies and Procedures

    Thank you for allowing us to be your healthcare provider. Our office is committed to the success of your child's treatment. The following is a statement of financial policy. Please read, type your initials to indicate your agreement with each of our policies. Your initials represent your legal signature.
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