Intake Form

Before you can make an appointment for your child we must obtain important information needed to begin the process so that we can provide you with the best possible services. You can be sure that members of the Sparks Clinics staff will be here to assist you in any way that we can. The Form consists of 11 pages counting the cover letter. Please complete the form and mail it to the address provided on the first page of the form. It is important that you complete all portions of the form. If you have trouble completing any sections of the form contact us at:
1-205-934-5471 or 1-800-822-2472

IMPORTANT INFORMATION FOR FAMILIES: 
If your child does not currently receive services and is suspected of having a developmental delay, please contact Child Find at 1-800-543-3098 for Alabama's Early Intervention Services (for children 0-3 years of age), or the preschool special education coordinator at your local school system for those children who are ages 3 and over but not yet in kindergarten.  If your child is in school but not receiving services, and you believe they should, please request your school evaluate them.  Do not wait for your appointment with us. 

You will need Acrobat Reader to download and read the intake form. If you need this program click here for the free download.

Below is the link for the Intake form, "I am going to the Sparks Clinics at UAB!" booklet, Family Resource Room flyer, and the UAB privacy policy.

Notice of Privacy Practices
sparks intake questionnaire for children 4 years and over.pdf
sparks intake questionaire for children under 4 years of age.pdf
sparks booklet.pdf