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pediatric speech & occupational therapy therapy intake form
pediatric speech & occupational therapy therapy intake form medical history: 1. Has your child experienced any of the following? (Please check all that apply) Chicken Pox Seizures Frequent ear infections or fluid in the ears[PDF]
1 PEDIATRIC OCCUPATIONAL THERAPY INTAKE FORM Client Information Child’s Name: DOB: Gender : qF M Home address : Street Apt : City : Province : Postal Code :
Occupational and Physical Therapy Clinic | School of
All services are provided by New York State licensed physical and occupational therapists. The Clinic is available for the treatment of a variety of diagnoses and patient populations including: orthopedic, neurological, hand, performing artists, and pediatric. Occupational Therapy Services require a physician referral in order to be treated.
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