Prior to your initial intake interview, you will be asked to fill out:

                      -Reinforcer Interview Form

                -General Intake Form or Toilet Training Intake

                      -Consent to Release Form & Photo Consent Form

For the General Intake Form click here

For the Consent to Release Form click here

For the Photo Consent Form click here

For the Reinforcer Interview Form click here

For the 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:

Potential Inc.                                    Fax: (215) 579-6960
638 Newtown Yardley Road
Commons West, Suite 1F
Newtown, PA 18940