Application Forms

This website contains forms to be completed prior to your appointment. Please fill out all forms one week prior to treatment date. If you have additional information, such as school report or therapy reports, then please forward those as well. Should you have any questions about the completion of these forms, please call me at (917) 860-3373.

Download all forms here at once in Zip File

Download the Parent/Client Contract here:

Parent -Client Contract

Download the Patient Initial Evaluation Form here:

Patient-Initial Evaluation Form

Download the Referral Form here:

Referral-Form

Download the Videotape Consent Form here:

Video-Tape-Consent Form

Download the Parental Consent Form here:

Parental-Consent Form

Download the Consent to Release Form here: