Thank you for your time and patience! We understand how daunting and time consuming filling out forms could be. We are always striving to make things as smooth as possible. However, these forms will give us the information we need to better serve you and your child.
Online Submission
Forms if printing is preferred
Welcome Packet (Required)
Intake (Required)
Please complete this form in the center or by faxing, mailing, or emailing to our office. If all of the above options are NOT feasible please print and give to your therapist on your first visit so that your therapist can better understand your child's needs and developmental history before the commencement of services.
Credit Card Authorization (Required for all private pay clients)
Please return via mail, email, fax, or via scanned submission and/or to the therapist on the FIRST visit
Authorization to release information (RECOMMENDED)
Out of Network form for GHI
This form should be filled out by the parent to be reimbursed for services rendered. Please refer to the Welcome Packet regarding insurance policies.
Out of Network form for Empire Blue Cross Blue Shield
This form should be filled out by the parent to be reimbursed for services rendered. Please refer to the Welcome Packet regarding insurance policies.
Mealtime Questionnaire
If your child will be receiving feeding therapy please fill out these forms for us to better understand your child's challenges with mealtimes