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City Speech Center
Shira Seltzer, CCCSLP6715 Level land Rd. Dallas, TX 75252
Telephone: 9725891803Client Profile
(Child)
Today's Date:
Child's Information
Name:
Phone:
Address:
Siblings:Who referred
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Who needs child intake form-s dallasdoc?
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Parents or legal guardians of a child who wishes to receive medical services or enroll in a program offered by DallasDoc.
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What is child intake form-s dallasdoc?
The child intake form-s dallasdoc is a document used to collect information about a child's background, health, and any special needs.
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Parents or legal guardians of the child are required to file the child intake form-s dallasdoc.
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The purpose of the child intake form-s dallasdoc is to assess the needs of the child and provide appropriate care and support.
What information must be reported on child intake form-s dallasdoc?
Information such as child's name, age, health history, allergies, medical conditions, and emergency contacts must be reported on the child intake form-s dallasdoc.
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