CNS Clinic  
Hickory:
Fax:
Lenoir:
Fax:
1-828-267-1688
1-828-267-1690
1-828-754-5550
1-828-754-5558


Please Read the Following Before Proceeding
Sensory & Developmental History Form
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On the next page, you will be asked to put in your Name, email address and create a password. This is simply to let you be able to access the completed form so you may print out out for your records.

Fill it out the Sensory & Developmental History Form to best of your memory and click Submit and it will be sent to our CNS staff. You may preview your form before submitting at any time.

Check the box below to verify your parental consent to share your child's personal information with the CNS Staff. We will not share this information with any other third party without your prior consent.



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