Please complete the intake form for the service(s) you are interested in pursuing for your child! In addition, please send the additional documentation needed to our fax at 504-565-7329 or email info@tlcnola.com. We will reach out to you to schedule your child's evaluation once all documentation is received. Thank you!
 

Speech Therapy Forms

New Client - Speech Therapy Form

Please also send:
1. Referral for speech therapy from your child's pediatrician
2. Hearing screening done within the last year

Occupational Therapy Forms

New Client - Occupational Therapy Form

Please also send:
Referral for occupational therapy from your child's pediatrician
 

Feeding Therapy Forms

Feeding History

Please also send:
Referral for feeding therapy from your child's pediatrician
 

Physical Therapy Forms

New Client - Physical Therapy Form

Please also send:
Referral for physical therapy from your child's pediatrician