New Clients - Children’s Intake Questions

You can submit the new client form online, or if you prefer, you may download and print the form below:

New Client Form (PDF) (Word)

Please fill this out in order to give me an idea of what your child can currently do on their own, how much they are able to explore on their own, and what tubes or other devices I should be aware of. Starred Fields will help the most.
  • Note: Please do not bring loud toys or toys with flashing lights.
    Bring 1 or 2 quieter toys that your child can interact with in a cause and effect manner.

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