Only complete this form after you have contacted one of our clinics and have
been scheduled for an appointment. You may download and print out our
Patient Intake Form (PDF).
Kids Developmental Clinic does not discriminate against any person on the basis of race color religion national origin disability or age in admission
treatment or participation in programs services and activities or in employment. Kids Developmental Clinic complies with the standards for privacy
of patient information required by the Health Insurance Privacy and Accountability Act (HIPAA). For further information about our policies and standards
please contact Diana P. Dinn at 713-668-6690.