Patient Intake & Referral

To be completed and submitted by parents/caregivers PRIOR to initial evaluation
Once we have received all required information our administrative staff will work with you to schedule your child’s evaluation and ongoing therapy appointments (if necessary) as quickly as possible. Buttons below will direct you to secure forms for Intake and Referral.
Intake Questionnaire
Intake Questionnaire - under 3 yrs
Group Application
Acceptance of Policies

Policy and Authorization

These forms cover our policies, agreements, treatment and HIPAA regulations provided at Kids at Play Therapy
For your convenience we have provided forms online to download, fill out and return to Kids at Play Therapy. You will find information on attendance and treatment guidelines as well as permission to use your child(ren) image for the purpose of promoting and highlighting the care and treatment at KAPT.
Photo Release
Attendance & Clinic Policies
Consent to Treatment
HIPAA Policy
From Our Staff

One of the greatest benefits of being at Kids at PlayTherapy is being part of your lives and having the opportunity to talk and share with you, the families. You encourage us to go beyond, to search for new and different answers, new methods to help your children. To think outside the box!

As therapists, we may be the ones who spent some specialized time in universities to help your children, but you are the professionals who live the daily life and know what we can only assume. It is in partnership that we gain so much more TOGETHER.