Your Name
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First Name
Last Name
Your Child's Name
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Your Child's Date of Birth
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Your Email Address
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Tell us about your location : where you are now, and where you are heading (if applicable):
What school does your child attend, and what grade is he/she in now (if applicable)?
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Does your child have a diagnosis of a learning or cognitive disability?
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What primary concern do you have for your child? How long has this been a concern? Does this concern present itself at home, school, or both?
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Do you have a secondary concern? If so, please describe it, and whether it is at home, school or both below.
Has your child received special services within or outside of the school before? If yes, please describe the services, and the duration.
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Does your child have an Individualized Learning Plan, IEP, etc...?
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Does your child have any medical or health issues? If "yes" please describe.
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Does your child take any medications?
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Has anything been tried before for your concerns for your child? If so, please indicate what was done, and for how long.
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Do you have any local special educational or therapeutic resources? If so, please describe them.
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IDS is not a direct service provider with any Health Insurance companies, although families often seek and receive reimbursement for our services. Do you have health insurance for which you will be seeking reimbursement? If so, please indicate the health insurance company you have.
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Please share anything else with us here that we should know prior to our intake with you.
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