Prior to your initial intake interview, you will be asked to fill out and return to us the following documents.
To download the forms, simply click the link next to each form.

1. General Intake Form    click here
   

2. Consent to Release Form   click here
   

3. Photo Consent Form   click here
   

4. Toilet Training Intake Form   click here
   
   

Current and previous clients are encouraged to
fill out our Satisfaction Survey. This will allow us
to better serve you and the community.

Click here for the Satisfaction Survey.

Forms can be fax or mailed to:

1. Potential Inc.
   638 Newtown Yardley Road
   Commons West, Suite 1F
   Newtown, PA 18940
   

2. Fax: (215) 579-6960