Forms to Complete for Child Therapy
Please complete the required fields, and click to submit, on the document below in order to setup a patient account. Upon receipt of your completed form, we will contact you with an appointment if we have an opening at the time your application is processed. If you do not hear from us, it means that we were unable to find an appropriate appointment, and we do recommend continuing your search for a provider.
During the first 30 days, appointments are given on a ‘first come, first served’ basis by the date your documents are received. We recommend calling our office at the beginning of each calendar month to update your continuing interest. Doing so moves your application to the current month’s list. Barring any insurance or treatment issues, those who contact us and have an intake on file longer than 30 days will be placed in an opening if one is available at the time of their call. Additional forms may be requested at the time of placement with a therapist.
After completing all of the required fields, a submit button will appear which will encrypt the documents before sending.
Downloading the documents will ERASE your responses. There is a 60 minute time-out limit.