Patient Forms
Initial Evaluation Consultation
Please download and fill out these forms for your first visit. You can submit your completed forms below.
For Adults
For Children (6-17)
- Intake Form
- Clinical History Questionnaire
- Release of Information to FPI
- Release of Information from FPI
- Attention and Behavior Rating Form (English)
- Attention and Behavior Rating Form (Spanish)
- Functional Assessment Checklist: Home Version (English)
- Functional Assessment Checklist: Home Version (Spanish)
To be completed by Teachers:
Follow up Treatment Evaluation Session
Please download and complete these forms for your follow up treatment evaluation session. You can submit your completed forms below.