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For example: "speech," "picky eating," or "focus at school." Please do not share diagnoses, medications, or medical records in this form. We will go over the details with you on a call.

This form is not for emergencies. If your child is in immediate danger, call 911 or go to your nearest emergency room. For a mental health crisis, call or text 988.

By sending this form, you agree that our staff may contact you by phone or email about your inquiry. Read our privacy policy. Our Notice of Privacy Practices explains how health information is protected.