Forms to Receive Services
Preliminary paperwork needs to be submitted before evaluations and therapy can be scheduled.
Pediatric Clients
- Acknowledgement of Receipt of Notice of Privacy Practices
- Pediatric Case History
- Authorization to Observe
- Authorization to Photograph, Video, Audio
- Intake Form
- Confidentiality of Records
If your child has had a diagnostic within the past 6 months, please submit it, or complete the Request for Records Form
Adult Clients (not with an acquired neurological condition, such as stroke or TBI)
- Acknowledgement of Receipt of Notice of Privacy Practices
- Adult Case History
- Authorization to Observe
- Authorization to Photograph, Video, Audio
- Intake Form
- Confidentiality of Records
If you have had a diagnostic within the past 6 months, please submit it, or complete the Request for Records form
Adult Neurological Clients (with an acquired neurological condition, such as stroke or TBI)
- Acknowledgement of Receipt of Notice of Privacy Practices
- Adult Case History Neurological
- Authorization to Observe
- Authorization to Photograph, Video, Audio
- Intake Form
- Confidentiality of Records
If you have had a diagnostic within the past 6 months, please submit it, or complete the Request for Records form