Welcome to the Main Line Pediatric Therapy Center! Here are forms for each new client to fill out after completing your initial telephone intake and an evaluation date is scheduled. You are now ready to review our packet of information, which can be found linked to the bottom of this page. Please fill out the forms and mail or e-mail them prior to your first visit. If you can not return them back in time,
bring the completed forms with you to your appointment.
What is included in our packet of information?
Initial Evaluation Information (how to prepare for the initial evaluation)
Background Information Form (medical history and background information)
Release of Information Form (authorizes us to send our reports to whomever you designate, such as any doctors, agencies, schools, etc. that are currently involved with your child)
Medical Records Release Form (gives MLPTC permission to obtain records from any doctors, specialists, or other agencies who have previously seen your child)
Cancellation Policy (please sign)
If you have any questions, please do not hesitate to call.
Abbe Bernstein Avart
Main Line Pediatric Therapy Center, Inc.