Kids In Sync - Client Intake Form
Thank you for your interest in Kids In Sync. Our mission is to provide child and family centered therapy. We take a bottom up approach to the therapeutic process, which allows us to create a treatment plan that best supports each child and their family. At Kids in Sync Pediatric Occupational Therapy, we specialize in the treatment of children with sensory integration disorders, and disorders in relating and communicating, including regulatory disorders, autism spectrum disorders, and pervasive developmental disorders.

REQUIRED INFORMATION:
1. Child demographics
2. Parent information
3. Pregnancy and birth history
4. Infancy and Childhood information
5. Previous intervention / testing
6. General Development
7. Education


This packet includes the initial information forms, along with information related to our policies. Please return these forms and any prior evaluations/ treatment reports to our office so that we can become better acquainted with your child prior to our initial evaluation / visit.
For occupational therapy services we are required by the State of Illinois to have a current referral (prescription) on file, from the primary care physician.


ARRIVAL / LATE ARRIVAL: Please plan on arriving 10 minutes prior to your scheduled appointment. This is will allow for any necessary time to check-in. We strive to see all clients at the time of their appointment. Any delay in your arrival time will shorten the time the therapist has to set aside for the initial visit with you and your child; please know that you
may be asked to reschedule your appointment if you are late.

In order to better acquaint ourselves with you and your child and to be able to share information during our initial visit we ask that siblings do not accompany parents to our clinic during our initial meeting and/or evaluation. Thank you in advance for your consideration in this matter.


CANCELLATION: Required at least 24 business hours in advance. If we are not able to take your call, please leave a message so that we may reschedule or cancel your appointment with the therapist. If you need further information or if we can answer and questions, please feel free to call our office.

For more information visit our website at www.kids-in-sync.com


IMPORTANT: Please use the email address you'd like to use for future communication. A link to edit or change form responses will be sent to this email address.

Email address *
Do the therapists and staff of Kids in Sync have your permission to leave messages containing medical and /or financial information on your voice mail? *
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