Child Evaluation: What Do I Bring to the Initial Evaluation

Forms not submitted online should be printed, filled out, then sent via fax/mail, or presented at the time of your visit.

• Insurance Card

• Service Agreement Form

• Prescription/ Physician’s Order Form for evaluation
  ** IN ORDER TO DO AN EVALUATION, FAC NEEDS TO HAVE A PRESCRIPTION**

• Registration Forms

  Please complete the step(s) in either of the shaded boxes.

  1. Submit online (secure)

     • Child Intake Form

     • Patient Registration Form

  2. Print and deliver

     • Patient History Form Child

     • Patient Registration Form

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