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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!
 

Credit Card Authorization Form

All clients are required to complete a credit card authorization form to be used if payments are not received by the deadline. Please complete and return this form to the office. 

Speech Therapy

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

Occupational Therapy

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

 

Feeding Therapy

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

 

Physical Therapy

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

 

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