Intake Paperwork | ctn-madison

When: Mondays
Time: 5:00-6:00 pm

Dates: June 17-August 19

Cost: $400 for 10 weeks

*Parents only - no child care provided*

Regulated Parents in Action

Come move, play, and learn with us! In this hands-on parent training series, we will dive into strategies to help regulate our children through the power of our own self-regulation. We will provide education and experiential opportunities
to help us understand how to use ourselves and the parent-child relationship to regulate our children. Each week we

will cover a topic that incorporates the use of sensory regulation, mindfulness, and yoga to positively influence our regulation so that we can approach parenting from a place
of fullness and abundance rather than emptiness and burnout. Parents will have practical tools to incorporate right away into daily life.

When: Tuesdays
Time: 6:00-7:00 pm

Dates: June 18-August 20

Cost: $50 for 10 weeks

*Parents only - no child care provided*

Circle of Security® Parenting™ Group

The Circle of Security® Parenting™ program is based on decades of research about how secure parent-child relationships can be supported and strengthened and helps us make sense of what our children are really asking from us. This is a 10-week course that utilizes video clips to present information about The Circle as well as examples of parents using The Circle with their children. Groups are a mix of watching video clips to learn new concepts and discussing and reflecting on our own experiences. This program is appropriate for all parents, those looking to learn a bit more, those who are struggling in their relationship with their child, as well as new parents, foster and adoptive parents!

Intake Paperwork

To get started with services at Children's Therapy Network, please complete the following forms:

General Intake Packet

Questionnaire for the applicable discipline: OT Questionnaire, SLP Questionnaire, MH Questionnaire, or PT Questionnaire

Prescription from your child’s physician to receive services: OT Script, SLP Script, MH Script, or PT Script

If you are an older teen or adult seeking occupational therapy services, please fill out and return the following paperwork:

Adult-Adolescent Intake Packet and OT Questionaire Adult Checklist

Evaluations completed within the past 12 months (one can also be completed by our staff)

Current IEP, if applicable

Copy of the front and back of your child’s insurance card

Any additional information you think would be beneficial for your child’s therapist to have

It is helpful to have the initial paperwork prior to the time of the evaluation, however, if this is not possible, please bring them to your first appointment. Intake paperwork can be faxed to (608) 819-6825 or emailed to info@ctn-madison.com.