The following questionnaire is to be completed by the patient's parent or legal guardian. This form has been designed to provide essential information before your initial appointment in order to make the most productive and efficient use of our time. Please feel free to add any additional information which you think may be helpful in understanding your child. KidsCare Therapy Center, Inc. will hold information provided by you as strictly confidential and will only be released in accordance with HIPPA guidelines and as mandated by law.