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Parent Information

As a pediatric therapy center, Thera-Play Pediatrics offers personalized therapy services to help children of all ages achieve the maximum potential of their abilities. With locations in Springdale and Fort Smith, AR, we strive to keep parents and families informed and involved in their child’s treatment. Below you will find important forms and helpful information for parents.

Pediatric Center in Springdale & Harrison, AR

Forms & Intake Paperwork

For your convenience, our patient forms are available online in English and Spanish. Please download, print, and fill out the appropriate forms for your child. Contact us if you have any questions.

English Forms

Spanish Forms

Signs of Autism

Many children with autism show developmental differences when they are very young. You should consider seeking more information from a neurodevelopmental specialist, as well as an occupational therapist, speech therapist, and a physical therapist if your child is exhibiting these signs:

3 Months:

  • Does not respond to loud music
  • Does not smile at people
  • Does not babble
  • Has trouble moving one or both eyes in all directions
  • Does not pay attention to new faces or seems frightened by new faces or surroundings
  • Experiences a dramatic loss of skills he/she once had

7 Months:

  • Seems stiff, with tight muscles, or floppy, like a rag doll
  • Head flops back when body is pulled to a sitting position
  • Reaches with one hand only
  • Refuses to cuddle and shows no affection
  • Does not respond to sounds
  • Does not turn head to find sounds (by 4 months)
  • Does not roll over (by 5 months)
  • Cannot sit with help (by 6 months)
  • Does not babble
  • Experiences a dramatic loss of skills

12 Months:

  • Does not crawl
  • Cannot stand when supported
  • Says no single words (not even “mama” or “dada”)
  • Does not point to objects or pictures
  • Shows no interest in games of peek-a-boo (by 8 months)
  • Does not learn to use gestures, such as waving & shaking head
  • Experiences a dramatic loss of skills

24 Months:

  • Cannot walk (by 18 months)
  • Fails to develop a heel-toe walking pattern or walks only on his or her toes
  • Does not speak at least 15 words
  • Does not use 2 word sentences
  • Does not imitate actions or words
  • Does not follow simple instructions
  • Cannot push a wheeled toy
  • Experiences a dramatic loss of skills

3 Years:

  • Poor eye contact
  • Limited interest in toys
  • Frequent falling
  • Difficulty with stairs
  • Persistent drooling or unclear speech
  • Cannot build a tower of more than 4 blocks
  • Little interest in other children
  • Cannot communicate in short phrases
  • No involvement in “pretend” play
  • Experiences a dramatic loss of skills

Signs of Dyslexia

Dyslexia is a learning disorder and a lifelong condition that affects how a person reads, writes, spells, and speaks. The signs of dyslexia can show up in children as early as preschool. While each case is unique, there are common traits and behaviors a child with dyslexia may exhibit, including:

  • A complicated relationship with reading
  • Difficulty reading out loud
  • Difficulty spelling words
  • Difficulty with sequenced instructions
  • Difficulty with organization & time management
  • Low confidence
  • Behavioral problems
  • Problems with pronunciation
  • An inclination to omit sounds & letters when reading & writing
  • Complaints of a headache or dizziness
  • Complaints that words on the page look “blurry” or “out of focus”
  • Confusion with “left” & “right”
  • Trouble with writing tools, like pencils or pens
  • A tendency to guess, skip, or replace words altogether instead of sounding out words
  • Strong oral comprehension but weak reading comprehension
  • A reading level below his or her peers


When Should I NOT bring my child to Therapy?

You should not bring your child to therapy if he/she is experiencing any of the following:

  • Illness symptoms withing the last 24 hours
  • Fever: temperature of 100 degrees or greater withing the last 24 hours
  • Diarrhea: Five or more loose, watery stools withing the last 24 hours
  • Vomiting
  • Difficulty swallowing or sore throat
  • Severe itching
  • Rash or any spots on the skin
  • Wheezing or difficulty breathing
  • Any open wounds that are not properly covered
  • Mouth sores
  • Eye discharge
  • Nasal discharge
  • Uncontrolled coughing
To learn more about our services and treatment options contact us today!

Phone: 479-856-6400
Fax: 479-856-6623

Monday - Thursday: 8:00 AM - 6:00 PM
Saturday & Sunday: Closed

Phone: 479-434-2371
Fax: 479-434-2009

Monday - Thursday: 8:00 AM - 6:00 PM
Saturday & Sunday: Closed