Please complete and submit this background form and COVID-19 screening questionaire for the child for both the child and person accompanying child, prior to your child's appointment. Bring Identification. Wear a mask while in public. Upon arrival, park in the back of the building or on the south side of the building or across the street, but NOT the north side as you may be towed. Call us telling us you have arrived. Wait in your vehicle until you recieve a call from us to enter. Enter at the backdoor of the building.
Call 859-200-1990
Child Information
Person bringing child MUST have legal guardianship or a written statement signed by legal guardian authorizing transportation and evaluation of child.
Parent Information
Social History
Developmental History
Educational History
Clubs, after-school activities, sports, band, etc.
Physical History
Psychiatric History
Daily Activities
Your information will be encrypted.
Being Prepared for the Child's Appointment
Please complete and submit this background form and COVID-19 screening questionaire for the child for both the child and person accompanying child, prior to your child's appointment. Bring Identification. Wear a mask while in public. Upon arrival, park in the back of the building or on the south side of the building or across the street, but NOT the north side as you may be towed. Call us telling us you have arrived. Wait in your vehicle until you recieve a call from us to enter. Enter at the backdoor of the building.