FREE Developmental Screening - Therapy 4 Kids
Therapy 4 Kids is providing free screenings for children at your pre-school. Please fill out the form below which gives Therapy 4 Kids permission to perform the free screening.

The screenings look at how your child is doing compared to other children their same age. These screenings DO NOT determine a need for therapy, only a possible need for a full therapy evaluation.

Since 2006, Therapy 4 Kids has provided Speech, Physical, and Occupational Therapy to infants and children of all ages in local pre-schools and our clinics which are located in Conway, Greenbrier, Clinton and Morrilton.

If you have any questions or concerns do not hesitate to call or text message us at 501-581-6045 or visit our website at Therapy4kids.net
Sign in to Google to save your progress. Learn more
Email *
Please fill out the information below
Child's Name *
Child's Date of Birth *
MM
/
DD
/
YYYY
Parent / Legal Guardian Name *
Parent / Legal guardian Phone Number *
Parent / Legal Guardian Mailing Address *
What pre-school does your child attend? *
Name of classroom at pre-school? 
What days and times is your child at pre-school?
Child's Doctor - Primary Care Physician
Child's Insurance *
Required
Is your child currently receiving any of these *
Required
What are your concerns?
Please type your name below giving us permission to perform the free screening for your child.
The End - It may take us a few weeks to perform the screening. If you have any questions feel free to call or text us at 501-581-6045. Visit our website at Therapy4kids.net and follow us on Facebook and Instagram.
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Therapy 4 Kids. Report Abuse
Google Forms