Patient Documents

Thank you for your interest in A to Z Pediatric Therapy & ABA to Z! Please complete the Inquiry Form below that best suits your therapy needs.

• New Patient Inquiry Form
  • For: Speech-Language Therapy and/or Occupational Therapy, or if you’re unsure where to start

• New ABA Patient Inquiry Form
  • For: ABA Therapy (Applied Behavior Analysis). Daily, clinic-based therapy support for Autism Spectrum Disorder (ASD)

Once completed, our team will review your information and reach out within 24 hours to discuss the next steps. We look forward to connecting with your family!

New Patient Packets:

• ABA Therapy: New Patient Intake Packet
• Occupational Therapy (OT): New Patient Intake Packet
• Speech Therapy: New Patient Intake Packet

New Patient Individual Documents:

1. New Patient Intake
2. Consent Form
3. Attendance & Cancellation Policy
4. Release of Confidential Information
5. HIPAA Privacy Notice
6. Media Release
7. Payment Policy
8. Credit/Debit Card Authorization
9. Parent/Guardian Questionnaire(s) for desired service(s) (section below)

• Speech-Language Therapy Questionnaire
• OT (Occupational Therapy) Questionnaire
• ABA (Applied Behavior Analysis) Clinical Interview (Autism Therapy)
• ST & OT Patient Re-Evaluation Form (for annual re-evaluations for current clients)

1. 2026 New Patient Intake Form PDF
2. 2026 Consent Form PDF
3. 2026 Attendance + Cancellation Policy PDF
4. 2026 Release of Confidential Information PDF
5. 2026 HIPAA Privacy Notice + Notice Acknowledgment PDF
6. 2026 Media Release PDF
7. 2026 Payment Policy PDF
8. Credit/Debit Card Authorization PDF
9. Parent/Guardian Questionnaire(s) for desired service(s) (section below)