Client Intake Form
Step 1 of 3 — all three forms are required for us to work with you as your independent facilitators.
This first form helps us get to know your family and your child's needs, your Regional Center, and where you are in the Self-Determination Program — so our first conversation is focused and useful.
Download PDFPrefer to print it? Download the form, fill it out by hand, and bring it to your consultation or email it back to us.
Finished this form?
Check it off to keep track of your progress. This is just for you — it doesn’t submit the form.
Stuck on a question?
Reach out any time — we're happy to walk you through any of the forms. We respond within 1-3 business days.