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Intake Paperwork
To get started with services at Children's Therapy Network, please complete the following forms:
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Questionnaire for the applicable discipline: OT Questionnaire, SLP Questionnaire, MH Questionnaire, or PT Questionnaire
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Prescription from your child’s physician to receive services: OT Script, SLP Script, MH Script, or PT Script
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If you are an older teen or adult seeking occupational therapy services, please fill out and return the Adult-Adolescent Intake Packet and OT Questionaire Adult Checklist.
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Evaluations completed within the past 12 months (one can also be completed by our staff)
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Current IEP, if applicable
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Copy of the front and back of your child’s insurance card
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And any additional information you think would be beneficial for your child’s therapist to have.
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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.