MAKE AN ONLINE PAYMENT
PATIENT PORTAL
MAKE AN ONLINE PAYMENT
PATIENT PORTAL
About ICCD
Clinicians & Staff
ICCD Canton Office
ICCD Newton Office
ICCD East Providence Office
Services
Applied Behavior Analysis (ABA)
Counseling Department
Consultative Services
Educational Services
Executive Functioning Coaching Services
Medical Services
Neuropsychological Assessment Services
Neuropsychological Assessment
Infant & Toddler Evaluation
Adult Assessment Program
Occupational Therapy Services
Occupational Therapy
Feeding Therapy
Speech & Language Services
Speech & Language Therapy
Common Speech Disorders
Augmentative & Alternative Communication Services
Transition Process Services
Appointments
Research Program Forms
Faq
Careers
Post-Doctoral Fellowship Program
Career Opportunities
Research Intern Program
Blog
Contact
Feeding Therapy History Questionnaire
Feeding Therapy History Questionnaire
Occupational Therapy
Parent or Legal Guardian Information
Parent's First Name
Parent's Last Name
Email
Address Line 1
Address Line 2
City
State
Zip Code
Phone
Mobile
Best time to call
Child's Information
Child's First Name
Child's Last Name
Date of Birth
Grade
Age
Insurance Subscriber
Subscriber address
Date of Birth
Upload insurance card - Front (jpg, jpeg, gif, png, bmp & pdf - 1 MB Max File Size )
Choose File
Upload insurance card - Back (if applicable)
Choose File
or input your insurance information
Primary Health Insurance
Policy #
Referred by
ICCD Office
ICCD office of choice
Canton Office
Newton Office
East Providence
Teletherapy
Description of concerns
Relevant Diagnosis
Precautions or allergies
What information do you hope to obtain from us?
Are you interested in an evaluation, ongoing therapy services, or both?
When are you available for therapy?
Submit
