Welcome to The All-Inclusive REI Custom Program

Online Intake Form for Children Ages Birth to 3 Years-old

Please complete the intake so we can begin making your custom program. Once completed, click the order button to submit it to us. We will get your first custom REI Custom Program track to you within 24 hours.

Call us at 800-659-6644 with any questions.

Instructions

Please select a rating for each of the following questions. Refer to behavior for the past 3 months. For each item, decide whether the behavior is relevant and to what degree.

• Not relevant = You never see this behavior
• Slightly relevant = You rarely see this behavior
• Pretty relevant = You ocassionally see this behavior
• Very relevant = You often see this behavior

Remember: Don't think too hard about the answer -- your first reaction is usually the right one.