All families must go through a 90 minute intake which entails getting to know one another, gathering history, identifying goals for treatment and completing the appropriate assessment measures. At the end of this meeting the psychologist will be able to provide you with suggestions for the type of treatment they would recommend moving forward. Typically this first meeting is made up of both the child and their parent(s), however there are cases when the child is not present. We will talk to you over the phone about whether your child should be present when the intake is scheduled.


Caregiver Intake Form


Demographic Information

  • If caretaker is employed:


Insurance and Referral Information

  • Who referred client to therapy?


Academic Information


Medical History

  • Current medication/previous medication (include all prescribed, over the counter medications & holistic/alternative remedies):

  • Developmental History:

  • Age at which developmental milestones were achieved: