Client Resources & Forms
Please find below documents you may need to fill out, sign, and return to Little Angels Center to receive services.
Early Intervention Forms
For PDF Forms Download, Fill Out, Save & Email to ei@littleangelscenter.com
- Parent Consent Form for the use of a CFY, COTA, PTA - PDF Form
- Intake Form IPRO Packet - PDF Form
Please Fill Out All the Below if Submitting Online- Child Illness & Make-Up Policy - Online Form
- Children with Allergies Intake - Online Form
- Confidentiality Policy & Procedures - Online Form
- Early Intervention Initial Intake - Online Form
- Professional Ethics Form - Provider and Family Agreement - Online Form
- Parental Consent for Interventionist - Online Form
- Parental Consent for Release of Information for Medicaid Funding - Online Form
- Transition Forms Tool Kit Packet - PDF Form
- Early Intervention Service Consent for Telehealth - PDF Form
- Fill Out Online Here
- Spanish Version Online Form
- Spanish Version PDF
- Early Intervention Email Consent for Teletherapy - PDF Form
- Fill Out Online Here
- Spanish Version Online Form
- Spanish Version PDF
- Family Assessment - Online Form
- Consent to Evaluate - Online Form
- Family Language Survey - Online Form
CPSE/Preschool Forms
For PDF Forms Download, Fill Out, Save & Email to cpse@littleangelscenter.com
- CPSE Case History - PDF Form
- Preschool Consent for Telehealth Services - PDF Form
- Fill Out Online Here
- Spanish Version Online Form
- Spanish Version PDF
- Preschool Email Consent for Telehealth - PDF Form
- Fill Out Online Here
- Spanish Version Online Form
- Spanish Version PDF
Insurance Case History Forms
We help empower
our clients to reach
their fullest potential!
Locations
Blue Point
235 Blue Point Avenue
Blue Point, NY 11715
(631) 363-5794
Fax (631) 363-8046
Medford
12 Platinum Court
Medford, NY 11763
(631) 868-3577
Fax (631) 576-4450
Smithtown
732 Smithtown Bypass, Suite 303
Smithtown, NY 11787
(631) 319-3350
Fax (631) 419-3880
East Yaphank
1490 William Floyd Parkway, Suite 107
East Yaphank, NY 11967
(631) 363-1980
Fax (631) 363-1979
Islip Terrace
1 Craig B. Gariepy Avenue
Islip Terrace, NY 11752
(631) 650-6545
Fax (631) 650-6546
Rockville Centre
77 North Centre Avenue, Suite 215
Rockville Centre, NY 11570
(631) 363-5794