Client Intake Evaluation

Help Us Personalize Your Child’s Journey

Please complete our Client Intake Form. While detailed, your insights are the foundation of our prescriptive sessions. Understanding your child’s history and goals ensures we deliver the most effective, tailor-made support from day one.

* Indicates required questions

At Lights On Learning, we believe in supporting the whole child. Beyond our summer activities, we offer specialized services you may find beneficial. Please check all that apply so we can provide a truly comprehensive learning plan:

Services List *

POLICIES:

Please read & sign the full policy document.
SUMMARY

  1. Prepay for all sessions once month at a time using a tuition-based model to hold your weekly therapy spot on the FIXED schedule.  Invoices sent by the 1st of each month. Payment is due in full by the 25th of each month.
  2. Prepay for all sessions at the time of scheduling to hold the therapy spot on the FLEX schedule.  No session will be held without payment.
  3. 48-hour cancellation policy. If you cancel with 48-hours’ notice, you may schedule make up sessions. Make up sessions need to be used within 1 month.  If you cancel with less than 48-hours, you can use the time for any family-centered service (online parent consultation, progress note, IEP review, etc.) Please indicate how you want the billable time to be spent before the session time.
  4. No refunds.

Fee increases by $5 each year on September 1st.

PAYMENT = AGREEMENT TO POLICIES SIGN AND DATE BELOW TO ACKNOWLEDGE YOU HAVE READ THESE POLICIES