Forms & Questionnaires

Clinical service forms

If you are new to our clinic and have an appointment, please review and fill out all the below forms. These forms will assist in making your check in process quick and easy.


Child History Form

Patient Manual

Health History Profile

Patient Information Sheet


Questionnaires can assist your provider in assessing and developing a treatment plan for your child.

Language Questionnaire-Autism in Toddlers (AGRE)

Modified Checklist for Autism in Toddlers- (M-Chat)

Mood and Feeling Questionnaire

Pediatric Symptom Checklist

Screen for Child Anxiety-Related Disorders — Child (SCARED)

Screen for Child Anxiety-Related Disorders — Parent (SCARED)



Yale-Brown Obsessive Compulsive Scale