Child Evaluation: What do I bring to the initial evaluation

• Prescription/ Physician’s Order Form for evaluation (This can also be faxed to the clinic at 651-738-9889 or mailed prior to the evaluation).  ** IN ORDER TO DO AN EVALUATION, FAC NEEDS TO HAVE A PRESCRIPTION**

• Insurance Card

• Registration Forms

  Print out and complete the following forms, then send them by fax or bring them to the clinic.

  • Patient History Form Child

  • Patient Registration Form

  • Service Agreement Form

  or:

  If these forms are not filled out, please arrive 15 minutes early to your evaluation to fill out paperwork.