Skip to content
310.365.0500
About Us
Our Team
Blog
Our Services
Occupational Therapy
Speech-Language Therapy
Physical Therapy
Orofacial Myofunctional Therapy
PACE
PACE testimonial
What to Expect
Payment Options
Intake Forms
Does My Child Need Help?
Contact Us
Intake Forms
Everyone Must Complete:
Acknowledgement of Receipt of Privacy Practices & Authorization and Release Form
Notice of Privacy Practices
Authorization for Photography and Recording
If Private Pay or Insurance Must Complete:
Credit Card Authorization Form
Financial and Office Policies
If Insurance Must Complete
Insurance Intake Form
If Regional Center Must Complete:
Regional Center Credit Card Authorization Form
Regional Center Financial and Office Policies
Intakes by Discipline:
Occupational Therapy Intake (OT Intake)
Physical Therapy Intake
Speech Therapy Intake for children OVER age 1
Speech Therapy Intake for children UNDER 1