Registration and Payment Please complete each step of the Registration form below and then continue to make a Payment. Please complete each step of the Registration form below and then continue to make a Payment. Registration and Payment Fill out each step to complete registration and continue to payment. Step 1 of 7 14% Client InfoName First Last AgeGenderPhoneEmail Parent InfoName (Required)* First Last AgeGenderPhone (Required)*Email (Required)* Second Parent Info (Optional)Name First Last AgeGenderPhoneEmail Family History / ConcernsWhat is occurring that has caused you contact Meyer EFS?Include The History and behaviors and any previous approaches/strategies you have attempted.Child’s interest’s and strengths: School InformationCurrent school and gradeDoes the client have an IEP or 504?Explain any suspensions or expulsions Medical HistoryIs the client taking medication? If so, what type and dosage?Has the client been hospitalized? If so, explain the circumstances.Is there a family history of mental illness or substance abuse? If so explain. Legal HistoryDoes the client have any outstanding legal issues or a history of legal issues.How did you find out about Meyer EFS?How did you find out about Meyer EFS? (Required)*CAPTCHA
