Pediatric Potentials Occupational Therapy Forms

Using microwave to prepare food


Please complete and submit online the following forms prior to your first appointment:

New Patient Information Online Form

Release of Medical Records


If you prefer to print and bring the forms with you please use these links for our forms.:

New Patient Information Sheet to Print

Release of Medical Records

and, if appropriate:

New Patient Information Form Newborn Infant

Sensory Processing Disorder Checklist

For Physicians or Other Referral Agencies:

Online Referral Form

Referral Form Printable Version


                                                                                                                Cooking is fun and can help with a myriad of skills
                                                                                                                including reducing tactile defensiveness, motor
                                                                                                                sequencing skills and visual motor integration.