New Client Form

Please print and fill out. This form will provide us important information regarding your child’s developmental and medical history. Bring this with you along with your insurance information.

Doctor Referral From

We do require a physician’s prescription be on file prior to any first visit with us. We will contact your doctor for you, but in some cases we may need your assistance. If your child has not seen their physician in a while, some doctors may require this in advance of writing a prescription. If you will be seeing your physician for this purpose, he/she can fax their prescription to us at 614-808-3563. We have included a Physician Referral Form below for your convenience.