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New Client Forms

The specialists at Kiddos' Clubhouse want to ensure that each kiddo's experience is a fun and productive one. To maximize our efforts, we ask each parent for information critical to our success with each child.

Hard copies of all of our forms (located below) should be completed and returned to Kiddos' Clubhouse via mail or fax. For our therapists to gain the most knowledge and use your child's evaluation time the most efficient, please have all information returned to us at least 2 days prior to their evaluation.
Kiddos' Clubhouse Forms

Prior to your first visit to Kiddos' Clubhouse, please be sure you have completed the following:

• Gather any previous evaluations or information that would be helpful to the therapist.

• Obtain original prescription from pediatrician that states:  

  • Therapy requested
  • Frequency of treatment (times per week and number of weeks - ex. 2x/week for 26 weeks)
  • Diagnosis code

• Either bring in or fax all above information to 678.366.5886 at least 2 days prior to visit.

The information is needed before your first visit in order to ensure that the therapist can be better prepared.  This allows the therapist to devise a plan that will best suit your child and his/her individual needs.  Thank you very much and we look forward to seeing you soon.
New Patient Demographic and Insurance Information
(Protected MS Word Document)
Patient History
(Protected MS Word Document)
Medical Release Form
(Protected MS Word Document)
   

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