Child Client Information Form

Información del Cliente

In order to help us provide the best possible services to you and your child, please complete the following information.

Para proveerles los mejores servicios a usted y su hijo(a), por favor complete esta forma.


    Prenatal and Birth History (Información prenatal y sobre el parto)


    YESNO

    Motor Milestones and Language - Hitos Motores y del Lenguaje

    At what age was your child able to do each of the following: ¿A qué edad pudo hacer lo siguiente su hijo(a)?

    Medical History (Historial Médico)

    Statement of Concern (Declaración de preocupación)

    Educational Information (Información Educativa

    Family Information (Información sobre la familia)

    Sensory Profile (Perfil sensorial)

    Please describe your child’s responsiveness or sensitivity to the following sensory areas:

    Por favor describa la reacción o sensibilidad de su hijo(a) a las siguientes áreas sensoriales.

    Behavior information

    Check out our Reviews!

    5 star ratingI've been taking my child here once a week. She was not communication well and can get a little frustrating.... read more

    Gabie T. Avatar
    Gabie T.
    3 years ago

    5 star ratingI have been to my share of therapy clinics, and this is by far one of the best. It... read more

    Rebecca W. Avatar
    Rebecca W.
    2 years ago

    The clients with special needs of One with the Water love this therapy center.

    Kenneth R. Avatar
    Kenneth R.
    1 year ago