Pediatric intake form

And recorded short videos of the child’s function

Please fill out this form so we can determine if your child is a candidate for our program. Additionally, we need to see 2-3 short videos (30 seconds or less) of your child’s function as applicable. To upload these videos, please use the link below.


Please record the following for each category:

Physical therapy:
  • on the floor moving around by rolling or crawling
  • standing with and without braces
  • walking/running with and without braces
Occupational therapy:
  • fine motor play
  • using utensils for writing/drawing and eating
Speech therapy:
  • child talking
Feeding therapy:
  • eating/drinking

Please fill out our intake form:

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No matter how old you are or what challenges you face, we can help! Key to CP was created by Dr. Karen Pape, MD, and Pia Stampe, PT, DPT to provide a comprehensive and completely unique treatment experience for every client. We work with adults as well as parents of children with CP.

If you have questions, please contact us!

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