Language for Learning Screening Form

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Information Collection Notice: This intake form is used to determine clinician assignment, suitability of service, and prepare for our initial contact with you. The information collected will be stored in your child’s confidential client record and will only be accessible by those actively involved with your service.

  • Parent and Caregiver Information

  • Child Information

  • Office and Technology Requirements

  • Caregiver Requirements

  • Child Requirements and Pre-requisite Skills

  • Considerations for Group Learning

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