Rehabilitation Services for Children - Important Forms

Thank you for your interest in our Pediatric Rehabilitation services.  We look forward to working with you and your child.  Please complete the Intake Form, Child and Family History and the Developmental Checklist which is appropriate for your child’s age. 

Intake Form
Child Family History Form
Developmental Checklist 0-3 Form
Developmental Checklist 3-5 Form
Developmental School Age Form

After completing the forms, please mail them to:

Intake Coordinator
Outpatient Pediatric Rehab
P.O. Box 9130
Boulder, CO 80301-9130


Scan and email to:


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