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Child Assessment Clinic – History Form

To facilitate the intake process, please provide the following information to the best of your ability prior to your first session.

Thank you! We hope to respond to your inquiry within a couple of business days. At the start of the academic semester, August/September and January/February, we receive a large amount of inquiries and may be slow to respond.

If you have not received a response within a couple of business days, please leave a message on the clinic voicemail, 919-962-6906, or you email us at