Client Forms

Therapy Agreement: This is a therapy agreement form, which includes information about sessions, confidentiality and payment. This form is for all ages. Please complete this form and bring it with you to your initial appointment. (Click for PDF form)

Child Developmental History:This form is for children under the age of 14. This form asks you to explain your child’s developmental history so that we have a better understanding of their background. Please complete this form and bring it with you to your initial appointment. (Click for PDF form)

Assessment Information for Derogation:This form is for clients completing a derogation. It asks for background information as well as academic strengths of your child. Please fill it out and bring it with you to your first appointment. (Click for PDF form)

Adult Client Info: This form is for adults over the age of 14. This form asks for client information (phone numbers, e-mail address, emergency contacts, etc.). Please complete this form and bring it with you to your initial appointment. (Click for PDF form)

Credit Card Authorization: This form gives our clinic the approval to have your credit card on file and to charge it when necessary. Please complete this form and bring it with you to one of your appointments if you wish for us to have your credit card on file(Click for PDF form)

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