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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

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

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

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!