Diagnostic Assessment Packet

To begin the process for a diagnostic assessment for your child (under 21 years old), please fill out the form below then download the packet at the bottom of the page. (It will expedite the process if you call Glenwood at 205-795-3203 to see if we are a provider for your insurance before filling out the packet.)

    Your Name (required)

    Child's Name (required)

    Child's Date of Birth(required)

    My child is under 21 (If not, please call 205-795-3203).

    Child's Insurance Carrier (required)

    Location of Services Sought (required)

    Your Email (required)

    Your Telephone (required)

    Additional Comments

     

    Use the following link to download the packet for your area of service:

    Parent Intake Questionaire

     Please email the completed Assessment Packet to the Glenwood Intake Coordinator.