Please complete this form to the best of your ability so that we may provide the best possible service for your child. If your child has any recent reports completed by other health professionals (psychologist, speech language pathologist, occupational therapist, IEP, etc.), kindly bring copies of these with you at your first appointment or you may fax/email them in advance. Please note that all information given is kept strictly confidential and will only be released with the written consent of the parent/guardian. We look forward to meeting you and your child!