Contact Us
for Speech, Language, and Occupational Therapy and Learning Support for your school or your child
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Client Forms
ROI Forms
This form gives The Loop permission to speak with your child’s school or other specialists
Screening Authorization
Please complete this form if you are interested in your child receiving a screener
Patient Agreement
This intake paperwork provides us with the
consent and information we need to begin working with your child and provides you with useful information about The Loop’s policies and your rights under HIPPA
Learning Intake
If you’re interested in your child receiving learning support, please complete this form which provides us with additional information about your child’s learning profile
Speech and Language Therapy Intake
If you’re interested in your child receiving speech and language therapy, please complete this form which provides us with additional information about your child’s speech and language skills
Occupational Therapy Intake
If you’re interested in your child receiving occupational therapy, please complete this form which provides us with additional information about your child’s developmental and motor skills
Updated CC Information
Please complete this form if you need to update your credit card information
Insurance Form
Please complete this form if you need to update your insurance information
Secure File Transfer
Need to send us an outside report or other
sensitive information you’d prefer not to email? Use our encrypted file transfer instead!