In order for our clinicians and staff to prepare for your first visit to CRG, please complete and return the required forms at your earliest convenience. You may return your paperwork to CRG via mail, fax or email, or simply bring it to your initial appointment. We ask that you arrive 15 minutes early to allow us adequate time to process your information and respond to any questions you may have.
We look forward to seeing you!
9106 N. Meridian St., Ste. 100
Indianapolis, IN 46260
Fax: (317) 571-4470
***Please note that you will need Adobe® Acrobat® 9 or higher in order to type directly onto the forms and save your information.
All new patients need to complete the following:
- Registration Forms
- Infant Toddler Preschool Questionnaire Ages 1.5 to 5 yrs– To be completed by the parents or guardians of clients ages 1 1/2 to 5 years
- Child Adolescent Questionnaire – To be completed by the parents or guardians of clients under the age of 18
- Adult Questionnaire– To be completed by clients ages 18 and up
Based on the type of services you are receiving, these additional forms may be requested:
- Teacher Information Request Form – Child
- Teacher Information Request Form – Adolescent
- Assistive Technology Consult Intake Form
- Augmentative and Alternative Communication – Family Report
- Augmentative and Alternative Communication – Teacher Report
- Strategy Instruction/ADHD and Life Coaching Form
- Documenting Accommodations for Colleges or Testing Agencies (DACTA)
- Gap Year Intake Form – Student Version
- Gap Year Intake Form – Parent Version
- Career Assessment Intake Form