These forms are for all new patients. It will take you at least 15-20 minutes to complete in its entirety, and you are able to hit “save” and go back to the form if you have not finished it at one time. We appreciate you completing this form as soon as possible so we can start your file. We must receive this form at least 2 days before your first evaluation/session is scheduled, and sooner is preferred. We thank you for your thoroughness in answering these questions in order to enable us to provide you and your child with the best treatment possible!
CHILD New Patient Form (under 18 years old)
Speech/Language Therapy & OT Form – Child VersionMyofunctional Therapy Form
ADULT New Patient Form (18 years and older)
Speech/Language Therapy & OT Form – Adult VersionMyofunctional Therapy Form
For physicians, dentists, orthodontists, or other referral sources.
Download an editable PDF file of our Referral Form or click here to fill out the online version +