Intake Forms
Welcome to the Inclusive Therapy Center!
Thank you for your interest in our clinical services at Inclusive Therapy Center! To help in the first few steps of the intake process, here is a little bit of information about our ABA services and the intake process. Filling out the Registration Form provides us with all the information needed to get you on the waitlist(s) for services. We have also attached additional intake forms specific to the service(s) you have expressed interest in. These forms will provide the clinician with important information about the client and as such, we require that the additional paperwork be turned in prior to scheduling.
Fill Out these Forms
INTERPRETIVE SERVICES Form
ABA Intake Form
Client Communication
Agreement
INSURANCE BILLING INFORMATION and AUTHORIZATION Form
E-mail Consent
SIGNATURE and ACKNOWLEDGEMENT
Thank you again for your interest in our services. Please don’t hesitate to contact the intake coordinator with any questions or concerns. We look forward to working with you and your family!
Intake Coordinator Office: (952) 657 – 5705 Fax: (612) 545 – 0914 Email: info@inclusivetherapycenter.com