New Client Forms
Thank you for choosing Emerge Pediatric Therapy! We are excited to work with your family. Please refer to the Welcome Email you received from our office. This email will tell you which forms to complete prior to your first session. Upon completion, the forms will be automatically be sent to the clinic and distributed to the appropriate therapist.
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Pediatric Clients
Provider Notice of Privacy Practices
Please download, read, and save for your personal records.
Aviso de Prácticas de Privacidad del Proveedor
Por favor descargue, lea, y guarde para su registro personal.
3 Day Diet History
Please download and complete by hand. You can bring this with you on the day of the evaluation or you can send it ahead of time via mail, fax, or scan and email.
Formulario de la Historia de 3 Días de Dieta
Por favor descargue y complete a mano. Puede traer esto con usted en la día de la evaluación o lo puede mandar antes por correo regular, fax, o escanear y mandar por correo electrónico.
Adult Clients
Use this checklist to keep track of the forms you have completed. This is for personal use and manual entry of information. The checklist does not automatically keep track of completed forms.
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- Welcome Packet
- Caregiver Questionnaire
- Sensorimotor History
- Preschool Questionnaire
- School Questionnaire
- Three Day Diet History
- Detailed Feeding History
- Adult Client Welcome Packet
- Adult Client Questionnaire
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