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Please take a few moments and fill out the forms
on this page. All information is held
in the strictest of confidence and is used
solely for the purposes of
determining the best ACTION PLANS 
for your child.
 
 

Help me to get to know your child:
Child's first name, age and sex:
Describe your child's FAVORITE activity:
Describe your childs' MOST dreaded activity:
Please check the boxes that best describe behaviors your child exhibits on a regular basis: (please remember, behaviors will never cause a child to be turned away) My child:
is primarily non-verbal
avoids eye contact
puts most objects in his/her mouth
IS toilet trained
is NOT toilet trained
enjoys deep pressure (ie:massage,weighted vests)
enjoys light touch on arms,legs,face, back)
repetitive movements (ie:flapping,rocking,tapping)
self-injurious behaviors(ie:biting,hitting self)
injurious behaviors to others(ie:hit,bite,scratch)
There are others not listed here
I would rather discuss this in our consultation
Briefly describe what you hope to see accomplished by using GUS and Ther-a-dog Services:
Please indicate the best way to contact you:
Feel free to email me directly at: