CARE

Request an Appointment

Please complete the form below or call us at 414-363-2222 to request an appointment at the Children’s Performance Institute. A member of our intake team will follow up with you.

Following a brief phone call to discuss your primary concerns, we’ll explain our intake process and schedule an appointment. We make every effort to have your child seen as quickly as possible.

Request an Appointment

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Name*

Email*

Phone Number*

City*

State**

Child Information

Date

Date of Birth

Pediatricians Information

Pediatrician E-Mail

Pediatrician Phone

Reason for seeking treatment*

Additional Information

How did you hear about us?*

ChildrensPerformance.org

Pediatrician

Mental Health Provider (Psychologist, Social Worker, or Psychiatrist)

School Affiliate or Educational Attorney

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Parent/Educator Workshop

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Request an Appointment

CHILDREN'S PERFORMANCE INSTITUTE

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