NEW PATIENT INTAKE FORM

Thank you for choosing Village Therapy to help meet your child’s communication and feeding needs. Please take the time to fill out the Intake Form (submit at least 1 week prior to meeting with Rachelle) and include as much information as possible about your child’s developmental history as this information is critical for accurate assessment and treatment planning.

If your child has had any recent evaluations by other health professionals (e.g. psychologist, neurologist, developmental pediatrician, IEP, etc.), please email copies of the reports to Rachelle@villagetherapynj.com prior to to your appointment date, as this helps Rachelle to get the most accurate representation of your child’s current level of functioning across all areas of development. 

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