Working hard today for tomorrow's voices.

Intake Form And Questionnaire

Due to our non-profit status, we must keep the following information on file. Please be assured that your answers to these questions will in no way influence your child’s possible admission. Tomorrow’s Voices does not discriminate based on age, gender, race, or national origin.

Instructions: Please complete this document in its entirety (including copies of related information where requested) to best assist us with your child’s assessment.  Once you have completed the document we will schedule our therapist to have a brief interaction with your child.

Areas:

  1. Client Information
    • PLEASE INCLUDE COPIES OF DIAGNOSTIC ASSESSMENT
  2. Parent/Legal Guardian Information
  3. Medical Information
  4. Educational
  5. Adult Service Information
  6. There is a $100.00 non-refundable application fee to paid on the next page. If successful in being admitted, the application fee will be applied to your child’s tuition costs.

CLIENT INFORMATION

    

 

PARENT/LEGAL GUARDIAN INFORMATION

Parent #1

Parent #2

Guardian #1

 

MEDICAL INFORMATION

If yes, please list below.

 

Additional Medical History

 

EDUCATIONAL SERVICES INFORMATION

 

ADULT SERVICES INFORMATION

PLEASE NOTE:  In order for the client’s experience at Tomorrow’s Voices to be a success, we ask each family to attend team conferences, in-centre observations and parent/guardian workshops so that effective follow-through may occur at home.  This is mandatory for the client’s enrollment within the Tomorrow’s Voices program.

The client who will benefit most from enrollment at Tomorrow’s Voices is a client whose parent(s)/guardian(s) are supportive of the principles and practices of applied behavior analysis (ABA), specifically B. F. Skinner’s analysis of verbal behavior.  Tomorrow’s Voices will be incorporating a variety of methods and therapies into the client’s program, but the core program will be based on the principles and practices of Skinner’s analysis of verbal behavior.

Parent(s)/Guardian(s) must contribute at least 3 volunteer hours per month at Tomorrow’s Voices or in assisting Tomorrow’s Voices with any fundraising efforts, this volunteer assistance will help Tomorrow’s Voices in keeping our costs down.

Please submit completed application and questionnaire using the Next Step button below. There is a $100.00 non-refundable application fee to be paid on the next page. If successful in being admitted, the application fee will be applied to the client’s program fees.

Total Money: $0.00


Contact Information

 

441-297-4342

 

info@tomorrowsvoices.bm

 

TN Tatem Building - #60 Middle Road, Warwick WK03

Useful Information

 

Events Calendar

 

Autism Resouces

 

Training & Development

 

Membership Application

 

Volunteer Application

 

Patient Intake Form

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