FOCUS Therapy Patient Intake Forms

Please carefully read and complete each of the FOCUS Therapy Patient Intake Forms as directed by our administrative staff.  Not every patient intake form needs to be completed for every child, so it's important to check with our office staff first.

Online Patient Intake Forms

The following patient intake forms can be completed online:

Patient Intake Form

ADOS Testing Deposit Form

Assistive Technology Intake Form

Printed Patient Intake Form

The following forms must be printed, signed & returned to our office staff:

Medical & Insurance Release Forms

Black mother and daughter FOCUS Therapy patient intake forms

What You'll Need

Helpful documents/information you may wish to have on hand to help you accurately complete these forms:

  • Any diagnostic assessments or records
  • Insurance card (you will be asked to upload)
  • Current IEP, 504 plan, etc. (if your child is in school)
  • Names/addresses/phone numbers of parents, emergency contacts, primary care doctor, school, etc.
  • Basic medical information (including developmental history, allergies, diagnoses, medications, and treatments)

Note that submission of these forms is only for parents or caregivers who have already been in contact with our office staff at FOCUS Therapy.

To send a general inquiry about services or waitlists, please e-mail us at [email protected].

If you have any questions about our Patient Intake Forms, please Contact Us.

FOCUS Therapy Policies & Procedures

Need to review our policies & procedures? Here you go! (Best viewable on a desktop or laptop.)