client paperwork

So that we may quickly and effectively assist you, please read the below information, and bring all necessary paperwork and items to your intake appointment.

  • PARENT QUESTIONNAIRE: If you are the parent(s) of a child under the age of 18, please complete the Parent Questionnaire (download below). For your own privacy, please bring the completed form to your first appointment or mail it to us via U.S. Post. Do not email the form.
  • MEDICAL SCREENIING: If possible, please have your child's vision and hearing screened by his/her pediatrician prior to your intake appointment.
  • DOCUMENTS: Please bring COPIES of the the following items (we will need to keep them, and you will likely want to have the originals):
    - A photograph of your child
    - Past evaluations of your child (school, or private) where appropriate
    - Copies of any IEPS or 504 Plans from the past two years, if appropriate
    - Copies of your child's report cards for the past two years

Parent Questionnaire

Before your first appointment, please:
1. CLICK on one of the below links for a Parent
Questionnaire
in PDF or WORD format.
2. PRINT the form.
3. FILL OUT the form.
4. BRING the form to your first appointment, or MAIL it
to the below address. (To protect your privacy,
please do NOT email the form)

Learning Solutions for Learning Success
2 Main Street
Florence, MA 01062


PDF format
Word format

ASEBA Web-Link Questionnaires

You may be asked to complete an Achenbach questionnaire online, through ASEBA Web-Link, to help our team obtain additional information to fully and accurately assess your situation and prepare an appropriate treatment plan for you.

You will be given more detailed information about this online form during your first testing appointment at Learning Solutions. You will also receive instructions about how to log on to the Web-Link site to complete the questionnaire.

If you prefer not to fill the form out online, you may instead complete it in paper form at Learning Solutions.