Pediatric Forms (Ages 3-11)

As you have been instructed, please click on the forms below to download them.  Once you have downloaded them, please follow the directions below about how to complete and return the forms to us.   Additionally, please send us all previous documents you have – Ex: Prior evaluation reports, Reports from doctors or other therapists, Educational Reports, etc.

Please Note: If your child is above the age of 9, skip the first 2 files, and instead, scroll down to the “Pre-Teen” forms.

There are two ways to complete and submit these files:

  1. Open each form with a PDF program, and fill out the information on your screen.  Then save the file(s).   When you’re done, please send the saved files (and additional documents) to:  Or,  upload  the files directly into the form below

2. Print the forms, and fill out the information by hand.  Then scan the papers, and email them (along with any additional documents you have) to: Or, upload the files directly into the form below.        Alternately, if you prefer to mail the forms (and have booked an appointment at least 2 weeks in advance) you can mail the papers (a large, manilla envelope works best) to: Horizon Speech Therapy Services, 381 Park Street, Suite 1A, Hackensack, NJ 07601.

 If your child is above the age of 9, please use the forms below for “Pre-Teens”.


Click or drag files to this area to upload. You can upload up to 10 files.