We are thrilled that you are interested in receiving services at The Farm by Pediatrics Plus. Our top priority is that we keep your child safe and that we make sure your child is served at the location that best fits their needs and goals. Once this form is submitted our team of professionals will use the information to ensure safety and best placement for your child. Please fill out this form entirely, and someone from our team will be contacting you soon! If you have any questions, please feel free to email us at email@example.com.