If you're a new client, please complete the following forms and bring them to your first appointment.
If you would like me to coordinate your or your child's care with another provider (for example, an occupational therapist, school provider, couples therapist, pediatrician, psychiatrist, etc..), please complete this form to authorize release of information:
During the assessment phase, I may ask you to download and fill out these forms. I request that the forms are filled out separately by all parents, partners or other caretakers who are responsible for the child:
- Survey of Parenting Practices
- Family Accommodation Scale Anxiety (FASA)
- Ages & Stages Questionnaire- Age 3
- Ages & Stages Questionnaire- Age 4
- Ages & Stages Questionnaire- Age 5
- Devereux Early Childhood Assessment Assessment (ages 3-5)
- Pediatric Symptom Checklist (for children ages 6-12)
- Preschool Anxiety scale (for children ages 3-5)
- Screen for Child Anxiety Related Disorders (for children ages 6-12)
Note: To download Adobe Acrobat Reader for free, click here .