Age 1 to 17 – Child Patient Form Submission

CLIENT FORMS AGE 1-17
Parent/Guardian Intake Form
This form is required to start the process and to ensure we can offer you the service(s) you require.
PARENT/GUARDIAN INTAKE FORM
Requested Documents
Please send Report Cards, IEPs, and other relevant documents such as previous psychological reports.
ATTACH DOCUMENTS
Follow-up Forms (Age 1-17)
This form should be filled out if requested by your practitioner. You must be a registered patient with the clinic and have an upcoming appointment scheduled.
Parent/Guardian Summary Report Form_Short FormPATIENT SELF REPORT FORM