Forms

Below are several forms important to the evaluation process.

Intake Packet (needs to be completed prior to the initial consultation) – Intake Packet

Child Development Questionnaire – Electronic fillable version (needs to be completed prior to the initial consultation):

Child Development Questionnaire

To complete the Child Development Questionnaire, please download the form and then open it using Adobe Acrobat Reader. Adobe Acrobat Reader is available for free here: https://get.adobe.com/reader/

If users continue to have trouble opening and downloading the Child Development Questionnaire, it is best to run the Adobe Acrobat or Reader program first and then open the form from within the program.

When using Firefox or Google Chrome, the user may need to configure these browsers to open PDFs using Adobe Reader or Adobe Acrobat. Information on this configure can be found at:

https://helpx.adobe.com/livecycle/kb/xfa-forms-firefox-chrome.html

If you cannot download the form, a print-only version of the Child Developmental Questionnaire can be downloaded below:

Child Developmental Questionnaire – Print only version Child Developmental Questionnaire – print only

Notice of Privacy Practices – PDF

Privacy Notice – United States Department of Health and Human Services: http://www.hhs.gov/ocr/privacy/index.html