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Clinician Onboarding Intake Form

20 minutes to complete



This intake form is designed to gather detailed information about clinicians across disciplines for smart matching with families of neurodivergent children (ages 4–15). By capturing each provider’s background, expertise, approach, and personal style, we can optimize clinician-family fit. Research shows that a therapist’s skills, personality, and shared values play a critical role in building a strong alliance and improving outcomes. 

Note


All information collected will be used to ensure an optimal match between clinician and family based on clinical expertise, therapeutic style, and practical fit. The ultimate goal is to accommodate each family’s unique situation by pairing them with a provider who can “meet them where they are,” being flexible and responsive to their strengths and needs. 

Professional Background & Credentials

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Years of Clinical Experience
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Clinical Specialties & Scope of Practice

Areas of Specialty / Expertise

Which child needs or conditions are you most experienced with? Choose as many as apply:

Age Groups Served

What ages do you work with? Choose as many as apply:

Diagnostic & Assessment Capabilities

Choose as many as apply:

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Therapeutic Interventions & Services Offered

Interventions / Services Provided

Indicate which therapies or services you offer (including evidence-based and alternative approaches)

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Approach to Treatment

How would you characterise your overall approach?

Clinical Philosophy & Frameworks

Which guiding frameworks or philosophies shape your work?

Family Engagement & Collaboration Preferences

Family Involvement in Therapy: How do you typically involve or collaborate with the family?

Professional Values & Strengths

Core Professional Values

Select up to 3 that best represent you. Which values guide your professional work?

Key Strengths & Skills

What do you consider your particular strengths or talents as a clinician?

Communication Style

How would others describe your interaction style and temperament as a clinician? 

Personal Statement

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Logistics and Culture

Languages Spoken

Cultural Background & Competencies

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Preferred and Acceptable Service Delivery Modes

Contact Preferences

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Availability & Practice Logistics

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Any Additional Comments

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