Download forms

The forms necessary for a new client are below. Please download, print and fill out these forms prior to your visit.

 

Right-click and save target files to save files to your computer, or click to open in your browser.

 

 

General Forms

Clinical Services Agreement

 

Credit Card Preauthorization Form

 

Notice of Privacy Policy / HIPPA Agreement


Client Information / Initial Intake Form


Release of Information Form

CONTACT US TODAY

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540-437-4226 phone
540-437-4227 fax

1591 Port Republic Road
Harrisonburg, VA 22801

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Interest
Speech Therapy
Occupational Therapy
Physical Therapy
Social Skills Training
Sensory Integration
Autism
Other

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