All forms (other than registration forms) must be completed and returned to the office in person or by mail. Forms cannot be submitted online. Please do not email forms because they contain confidential information. Mail or bring forms to: The Children’s Program, 6443 SW Beaverton Hillsdale Hwy Suite 300, Portland, OR 97221
Please complete the forms using one of the two following methods:
- Print out the forms one page at a time, no two-sided copies please, and then complete them.
- Complete forms on your computer via PDF.Please note, some of these forms require Adobe Acrobat to display and print. You may fill out the forms online and print or download to fill out and print. Forms must be printed out and returned to the office. If you cannot print out the forms, please call the office and we will mail the forms to you.
If you have any questions about completing these forms, please call our office (503) 452-8002, or the Intake line, (503) 548-4844. Our fax number is (503) 452-0084.
You only need to complete one of the packets below, either a client packet or a group packet.
Please check your printer settings, be sure to print each page individually not two-sided or duplex.
1. Release to Disclose Confidential Information*: PDF
2. Speech/Language Intake Evaluation (for current or returning clients)*: PDF
3. New Client Registration Packet*: PDF
4. Speech/Language New Client Registration Packet*: PDF
5. Adult Client Registration Packet*: PDF
6. Returning Client Packet*: PDF
7. ADD/ADHD Beginners Group Packet, Winter 2019: PDF
8. Pay Attention to Attention Group Packet, Winter 2019: PDF
9. Coffee Club Packet: PDF
10. Girls Group Packet: PDF
11. The Incredible Years Packet and Calendar Fall 2018: PDF
12. Seeing My Time Packet and Calendar Winter 2019: PDF
13. Consent for Use of a Language Interpreter: PDF
14. Consent for Use of a Language Interpreter – Spanish: PDF
15. Vanderbilt Assessment Scale – Parent: PDF
16. Vanderbilt Assessment Scale – Teacher: PDF
*To view and print a list of individual forms contained in these packets click here.
Please note, some of these forms require Adobe Acrobat to display and print
Please send questions or comments to email@example.com