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Initial Intake Form

Start with this form. It will give us an overview of your demographics and needs.

Pediatric History

If you are looking for services for a pediatric client please complete this form with their history.

Adult History

If you are an adult looking to get services please complete this history form.

Consent for Obtaining Information

This form is to give us consent to reach out to other professionals who are part of your care team to collaborate about your care.

Physician Referral Form

If you are being referred by a physician please have this form completed. If you intend to get a Superbill for potential reimbursement from your insurance company this form will need to be completed.

Consent for Services

This form allows us to give services to the patient with signed consent.

Tele-practice Consent

This form give us consent to hold therapy via tele-practice.


This form informs you about your HIPPA rights.

Referral Form

This form helps us know how you found out about us and aids us in our marketing efforts to reach more families like you! Thank you for completing this form during your intake to help us help others like you! We appreciate you completing just one more form!