Pediatrics
Child History Form
Birth history, milestones, feeding, school notes, and what you are noticing at home. Bring any IEP, 504, or prior evaluation if you have one.
Download PDFIntake
Child History Form and Adult History Form.
These are the same packets linked from the current Summit homepage. Fill out the form that matches who is coming in, or request a consult and we will walk you through it.
Adults
Adult History Form
Medical history, medications, swallow or voice changes, work demands, and goals. Imaging or hospital discharge notes help when they exist.
Download PDFPrivacy
Rights and Responsibilities
Notice of Privacy Practices and client rights, as published on the live Summit site.
Download PDFAfter you download
A free telephone consultation is still the usual first step. Our front office can tell you which packet to send back. Questions: [email protected] or fax (385) 275-6764.
Next step
Request a free telephone consultation.
Better communication starts today. Our front office picks up during phone hours, no forms, no self-scheduling, no wait list.