Referral Intake

Thank you for contacting our Practice.   We are booking new assessment for June 2022 and therapy referrals for January 2023.  If you would like to be seen at that time, please complete the intake form on our website.  Dr. Pure has a number of colleagues to whom she is redirecting referrals. If you wish to have contact information for them, please let us know at

All information parents provide is confidential.

Step 1 of 4

  • Parent Guardian Information

  • This form is configured to send a confirmation email to this email address.