Intake FormsThe purpose of the Initial Intake Form is to provide Therapeutic Connections with the all information we need to evaluate your child so we may design an inclusive treatment plan based on your child's individual needs. We require information in the following areas:
- Patient Information
- Background information
- Prenatal / Birth History
- Developmental History / Milestones
- Medical History
- Functional Status
- Sensorimotor Processing
The form also covers the Attendance Policy and Payment Policy for Therapeutic Connections.
The Intake Insurance Form is used only for the purposes of Therapeutic Connections insurance and payment obligations. Please provide information in the following areas:
- Patient Information
- Insurance Information