United Way Grant Form

Income verification is only required if you are approved for funding through the Capital Area United Way ALICE Grant.

We're so glad you're here!
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Please use the link below to download our new patient   packet.  You may either complete these forms and return them via email or bring them with you to your first appointment.

​We can't wait to meet you!

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Formularios españoles para pacientes nuevos

New Patient Forms

OT Questionnaire

OT Feeding Questionnaire

Speech Questionnaire

ST Feeding Questionnaire

Physical Therapy Questionnaire

Patient Demographic Update Form

If you have received a patient statement and would like to make a payment on your account please use the link to the right.  Be sure to add the patients name or account number when submitting your payment.​

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Pay Here