Get Ca Therapeutic Learning Consultants Request For Services

This guide provides clear and comprehensive instructions for completing the CA Therapeutic Learning Consultants Request For Services. We aim to ensure that all users have a smooth experience while filling out this important document.

Follow the steps to successfully complete the request form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the child’s information. Fill in today’s date, last name, first name, age, date of birth, home phone number, address, city, state, and ZIP code in the respective fields.
3. Provide legal guardian information. Enter the full name, home phone number (if different from the child's), relationship to the child, cell phone number, and email address.
4. If there is a second legal guardian, repeat step 3 for them.
5. Document the child's diagnosis and the date of diagnosis in the appropriate sections.
6. Fill out the history of treatment section, providing the name of the behavior consultation provider, dates of services, and name of the provider agency. Indicate the frequency of provider services.
7. In the supportive services section, list any other services the child is currently receiving in school and out of school. Fill in the type of service/therapy and its location.
8. Describe any problem behaviors exhibited by the child in the dedicated space provided.
9. Indicate the current communication skills of the child, whether verbal, PECS, sign language or other methods.
10. Select the types of therapy services you are interested in receiving, such as assessment, home-based services, or school-based services, among others.
11. Fill out the funding information section by indicating the method of payment such as private pay, school district, medical insurance, or other.
12. Specify the preferred days and times for services to be provided. Fill in the schedule considering availability.
13. Finally, review all the completed information for accuracy. You can then save changes, download, print, or share the form as necessary.

Complete your request form online today to initiate the process.