Find the intake and release forms for our Assistive Technology services. Choose the one that fits your situation, complete it, and send it back to us.
Before your first appointment, we ask for a short intake form so we can understand your goals and needs ahead of time. Pick the form that describes your situation, fill it out, and return it to us. If any form is hard to complete on your own, contact us and we will help you finish it by phone, and we can provide any form in a different accessible format on request.
For adults seeking assistive technology services for themselves. It asks about your goals, the tasks you want to do, and your access needs.
Open the Adult Client Intake Form in Portable Document Format (PDF) (opens a new page)For a parent or guardian requesting services on behalf of a child. It gathers background about your child and the support you are looking for.
Open the Parent Intake Form (PDF) (opens a new page)For schools and districts requesting an assessment or services for a student. It collects the details our team needs to prepare.
Open the School Intake Form (PDF) (opens a new page)Gives us your permission to share information or media where needed for your services. Include it with your intake form when it applies.
Open the Information & Media Release Form (PDF) (opens a new page)Return your completed form whichever way is easiest for you:
Prefer not to use the PDF? Call us at (510) 841-3224 and we can complete the intake with you over the phone, or send the form in a different accessible format.
