Speech, Occupational, Physical therapies, social work & Teletherapy

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Child's First and Last Name

Child's Birthdate

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Whats your child's gender?

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Describe the reason you are seeking therapy for your child

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What language does your child speak at home?

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What personality type does your child respond to best?

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What days and times work best for therapy for your child?

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Does your child have a diagnosis?

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Has your child previously received therapy?

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Parent’s first and last name

Address

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Would you like to receive an e-mail with your insurance coverage and cost information?

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Contact Info

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Is there anything else you would like us to know about your child?

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COVID-19 Protocol

We hope you and your family are continuing to stay safe and healthy! We have outlined our protocols for in-person sessions during COVID-19. As you know, the health and safety of our clients and therapists remain our highest priority. As always, please reach out with any questions or concerns. Thank you for your cooperation and understanding as we work together through these unprecedented times.


Hand Washing:
Upon arrival at your home, your therapist will wash their hands with soap and water and/or use hand sanitizer. We ask that you and your child also wash your hands and/or use hand sanitizer upon your therapist’s arrival.
 
Facemasks:
We are asking our therapists to wear masks upon entering your home and throughout your child’s session. That said, we understand that some children have adverse reactions to seeing adults in masks and will leave it up to you and your therapist to decide your comfort level while still taking safety precautions.
 
We ask that parents and caregivers also follow the guidelines and wear masks when sitting in on sessions. We will not enforce that policy, but we do kindly ask for compliance.
 
As for your child, we realize that masks may not be appropriate for every child so we will not enforce the rule that children over the age of 2 should wear a mask.  However, if your therapist insists that your child wear a mask, then that will be a requirement directly between the two of you. We respect our therapists’ individual comfort levels with safety precautions and ask that you respect them as well.

 

Protocol Acknowledgment and Health Certification:

Before your child’s first in-person session, we are asking clients to submit an acknowledgment of these protocols and a health certification, which you can find here. Thank you again for your cooperation and for helping all of us stay healthy!