Client Forms

Please use the following forms to submit information to EBS Children's Institute. You can either fill it out online or download and print the PDF and bring it to us. If you choose to fill out a form online, please know that we take your security and privacy very seriously. Online forms are hosted on EBS's secure, HIPAA-compliant server.
Insurance Information

Complete Online
Download/Print
HIPAA Acknowledgment

Complete Online
Download/Print
Consent to Release Information

Complete Online
Download/Print
ABA Therapy Intake

Complete Online
Download/Print
Occupational Therapy Intake

Complete Online
Download/Print
Physical Therapy Intake

Complete Online
Download/Print
Speech & Language Therapy Intake

Complete Online
Download/Print

Client Bill of Rights


Complete Online
Download/Print