STEP 1:
Complete the intake form below and submit.
Child's Name
Date
Parents
Birthdate
Address
Age
City
Zip
Home Phone
Email
Cell Phone
Teacher
Child's Physician
School
Referred By
Special Class
Type of Referral
Private    
Other
Presenting Problem
Testing or Treatment done previously or in progress:
Medical

Psychological
School
Other Information
Send reports to

STEP 2: Download the entire intake packet in pdf form. Please send the forms by mail or bring them to your 1st appointment. We will contact you when your forms have arrived. Our mailing address is: Developmental Pathways for Kids, 452 Grand Street, Redwood City, CA 94062

The intake packet contains the following forms:
Cover letter
DPK Contact Info Form
Individualized Needs Assessment
DPK History Form
DPK Sensory-Motor History for Preschoolers
Emergency Medical Form
Consent For Treatment Form
Notice of Privacy Practices
Release of Information Form

*Note: To download a free version of Adobe Acrobat Reader, click here.