HIPAA- Developmental History

  • Please select your correct location for each form.

  • General Information

  • Medical History

  • History of Pregnancy
  • Labor and Delivery
  • Medical History of Child

  • Developmental History

  • The approximate age your child achieved the following developmental milestones:

  • Speech-Language Development (check all that apply):

  • Gross Motor Development (check all that apply):

  • Fine Motor Development (check all that apply):

  • Family Information

READY FOR A FUN THERAPY ENVIRONMENT,
THAT TRULY CARES ABOUT YOUR CHILD AND YOUR FAMILY?

If you are interested in enrolling your child in the intensive strengthening program at PTS, please utilize the links below to complete the intake documents. Once your intake documents are received, you will receive a phone call to screen your child for the program as well as discuss scheduling. If you have any questions, please call (813) 662-1060.

Quality Therapy Specifically
For Children

About PTS

Contact Us

Brandon Location
P : (813) 662-1060
F : (813) 662-0530

Lakeland Location
P : (863) 802-3800
F : (863) 802-0480

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Terms & Conditions | Copyright Notice | Privacy Policy
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Services

Quality Therapy Specifically For Children

Occupational Therapy
Physical Therapy
Speech Therapy
Therasuit Method®
Feeding Therapy

About PTS

Learn About Us
Our Accepted Insurance
Open Positions

Contact Us

Brandon Location
P : (813) 662-1060
F : (813) 662-0530

Lakeland Location
P : (863) 802-3800
F : (863) 802-0480

© Copyright – Pediatric Therapy Services
Terms & Conditions | Copyright Notice | Privacy Policy
Website Designed by: MaximizeDigital.com