Download and print out the Education Consultation Forms.

(If you are experiencing difficulty downloading any Forms, try downloading Adobe PDF Reader if you do not already have it installed: https://www.adobe.com/products/reader.html )

Please hand write the information legibly. All signature pages must be signed by hand accompanied by the date of signature.

Accurate completion of these questions allows us to have a more thorough context for understanding your child’s educational profile and areas of concern. We will discuss this questionnaire at your initial visit and develop a plan tailored for your child’s unique learning style. Your initial visit will be 45 minutes. You should schedule our subsequent appointments (tutoring, consultations, IEP meetings, etc) at Square One’s front desk at the end of your initial visit.

Submit your Education Consultation Forms via fax: (502) 896-0487; via email: meds@squareonemd.com; or by mailing them to our office.

Email communications are password secure but not encrypted and may be subject to unauthorized redisclosure or hacking.

If you wish to drop off your forms in person, please call our office at (502) 896-2606 to arrange for a time for our administrative staff to assist you. For the privacy, confidentiality, and safety of our patients, we ask that all visits to the office are arranged ahead of time.