Download Client Forms

Once an appointment is scheduled, you will be invited to complete our New Client paperwork prior to the session through our online documentation portal (here) with IntakeQ. For your convenience, our intake forms may also be downloaded directly from this page as well. We kindly request that you complete these forms and return them prior to your first scheduled appointment.

  • For Speech and Language, Occupational and/or Physical Therapy, please only complete the General Case History.
  • For Social Cognition, Executive Functioning, Feeding, and/or Mental Health, please download the corresponding Client History form(s) in addition to the General Case History Form.
  • All new clients must also complete and return the Allergy Alert and Insurance Information Form prior to their first scheduled appointment

Client History: General Case History

HISTORIAL GENERAL DEL CLIENTE

Client History: Social Cognition

CUESTIONARIO DE COGNICIÓN SOCIAL

Client History: Executive Functioning

CUESTIONARIO DE FUNCIONAMIENTO EJECUTIVO

Client History: Feeding

CUESTIONARIO DE ALIMENTACIÓN

Client History: Mental Health

CUESTIONARIO DE SALUD MENTAL

Allergy Alert Form

Formulario de Alerta de Alergia

Credit Card Authorization

Autorización de tarjeta de crédito

Insurance Information Form

Formulario de Seguro

 

Please consider the environment when printing these forms (KidSense will happily accept them double-sided and in black/white).

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