Age 1 to 17 – Child Patient Form Submission

CLIENT FORMS AGE 1-17
Child and Adolescent Intake Form
This form is required to start the process and to ensure we can offer you the service(s) you require.
CHILD AND ADOLESCENT INTAKE FORM
Requested Documents
Please send Report Cards, IEPs, and other relevant documents such as previous psychological reports. Files must be in pdf format.
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