New Patient Forms


Please fill the following “New Patient Documents” that are linked below. The Patient Information Form and The Patient History Form need to be filled, saved, and emailed to Info@SynapticPediatricTherapies.Com. These are fillable documents; they do not need to be printed.

Steps to Fill and Send Forms:

  1. Click link for “The Patient History Form” or “The Patient Information Form” at the bottom of this page.
  2. Click “Download” in upper right hand corner of the form (The icon for “Download” is a Down Arrow Button).
  3. Open document in the location it was downloaded.
  4. Fill document with child’s information.
  5. Save document by clicking “File” then “Save As” in the upper left hand corner of the form.
  6. Send Document in email to Info@SynapticPediatricTherapies.Com.

This will take care of all the intake and insurance information needed prior to the evaluation. After the evaluation, your child will receive a plan tailored to his/her needs, and will be assigned weekly speech therapy appointments, if needed.

Please allow 45-60 minutes for the evaluation. Other children are welcome, as we have a waiting room with toys and games for them to enjoy.

We are a family owned and oriented clinic. We do care about any personal problems or issues you or your child may have. For any additional questions or concerns, please contact us directly at 972-454-9309.

SPT Patient Information Form

SPT Patient History Form