History / Application Form :

Before an evaluation can be scheduled, the history /application form must be completed. The history /application form is available as a Word document (.doc) format or as a Rich Text Format (.rtf) format. Click on the link below to download the form in your preferred format.

History / Application Form as a Word .doc document (63K)
History / Application Form as a Rich Text Format .rtf document (48K)

For clients transferring from another neurodevelopmentalist, please contact the Utah Office before you fill out this form.

E-mail: hopeandafuture@hotmail.com