SPOT On Registration – Intensive Therapeutics

Our SPOT On group is available throughout the school year on Thursdays from 3:30 PM to 5:00 PM, starting the week of September 13th, 2022.

SERVICES ARE PROVIDED AT:
Intensive Therapeutics, Inc.
31 Fairfield Ave
West Caldwell, NJ 07006

PHONE: 973-771-1582

EMAIL: info@intensivetherapeutics.org

SPOT On Group *

Registration Information

Child’s Name *

First

Last *

Last

Date of Birth *

MM/DD/YYYY

Age *

Gender

Parent’s Name *

First

Last *

Last

Home Phone

Cell Phone *

Phone Back Up

Email *

Address

City

State/Province

Zip/Postal

Country

Medical Information

Is your child on medications? *

Yes

Types of medications

Does your child have allergies? *

Yes

Please list allergies

Any other pertinent information?

Family Goals

What are one or two realistic / functional goals you would like to see your son / daughter achieve during this program?

History

Please describe briefly past attempts of participation in therapy/groups and current status

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