We are open to in-person visits but have updated our policy due to COVID. Click here to learn more.

Client Intake Form

Step 1 of 3

  • Client Information

    Please complete the information in the forms and we will get back to you for an appointment.
  • Date Format: MM slash DD slash YYYY
    Patient's Date of Birth
  • Age in years
  • Do you already have a diagnosis?
  • Please provide the name of your Primary Care Physician and the name of their Practice
  • Provide the Grade the child is in and the Name of the Teacher
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