Enrollment Agreement

Before you begin the intake form, here’s what you need to know:

• Plan to spend 20–30 minutes completing this form. If you need to pause - save your progress, as unsaved entries will be lost.
• Only fully submitted forms will be processed -  a PDF of the filled form will be available for download after submission.
• Completion of the form does not guarantee services. Our office will reach out if your concerns fall outside our scope of care.
• Currently we are scheduling evaluations 1-3 months in advance, and at this time we only have morning and midday appointments available for treatment. Late afternoon appointments are currently unavailable.  
• Please note that we require a current referral on file to schedule appointments. If your referral is more than one year old, please contact your primary care provider to request a new one. After submitting the intake form, you will receive a notification if your referral has expired.
• If we do not receive the intake form within two weeks, we will assume services are no longer needed and remove your child from our waiting list.

By continuing, I confirm that I have read and understand these conditions.