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    Forms
    (Please print, complete, and sign. To download these forms, you must have
    the Adobe Acrobat Reader. This may be downloaded at no-charge from
    www.adobe.com.)


    Welcome Packet Forms
    The following forms, as applicable, must be signed and completed atleast     
    10 days prior to the scheduled appointment. Please submit these forms
    promptly so that time will be maximized wisely during the patient's    
    scheduled visit.

    The Autism Questionnaire is a 27-page document that must be completed in
    order to provide the maximum information to the physician.


    Religious Exemption Certification Form
    Click on the link below and complete the form. Submit the form to the school
    nurse.



    International Shipping Forms
    The following forms are to be used for shipping laboratory specimens from
    overseas. Directions for the completion of the forms are attached. If you have
    any questions, please direct them to the specialized labs.

  • Urine Toxic Heavy Metals
  • Fecal Metals
  • Red Blood Cell Elements

  • Advanced Metallothionein Profile

  • CDSA 2.0
  • Elementary Hair Analysis
  • Parasitology

  • Myelin Basic Protein

  • Ion Profile

Avon Therapeutic Center
Avon Therapeutic Center
701 Cottage Grove Road
Suite C-010
Bloomfield, CT 06002
Tel (860)242-2200
Fax (860)242-2212
© 2005 ATC All Rights Reserved
A Treatment Center for Adults & Children with Special Needs
Avon Therapeutic Center