Before an evaluation can be scheduled, the history/application form must be completed. The history/application form is available in Word doc format and rich text format(.rtf). Click on the link below to open the format you want within the browser. To save to disk, in Internet Explorer, right click and select Save Target As... . In Netscape, right click and select Save Link As... .

historyform.doc (63K)
historyform.rtf (48K)

For clients transferring from another neurodevelopmentalist, please contact the Utah Office before you fill out this form.