Registration Forms

Select the appropriate paperwork for your Evaluation appointment.

Preschool

 

Preschool History Form

Symptom Checklist

Release Form

 

Student

 

Student History Form

Symptom Checklist

Release Form

 

Adult

 

Adult History Form

Symptom Checklist

Release Form

 

Print and complete all 3 forms for your age group.  Bring completed forms with you to the appointment.

For concussion or brain injury evaluations, complete the Concussion-Brain Injury Symptom Checklist instead of the standard Symptom Checklist.  Complete all other forms for your age group.