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Our Forms


Thank you for your interest in receiving services at Kids Center for Pediatric Therapies. We make every effort to schedule your child for services in a timely manner but want you to be aware that we may have a waitlist for specific services. For us to provide services, we will need a referral or prescription from your physician and will need the appropriate forms completed by you. Please complete all appropriate forms in their entirety.

If you are interested in our Spasticity Clinic or Feeding Clinic, please contact us to discuss scheduling an appointment prior to completing these online forms.

Each child is required to have one Registration Form and one General Intake Form completed. In addition, there are therapy specific forms to complete based on the service requested. If you are seeking multiple services, please complete all appropriate forms. You are welcome to contact Kids Center for assistance with your request for services.

If you are interested in services at Kids Center, please contact our scheduler at 635-6397 to request intake forms.