Request an Appointment - Early Childhood Screening

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Request an Appointment

Complete the necessary fields to request your appointment time.
Remember to note the selected date and time on the form; no confirmation email with this information will be sent.


* Parent(s) Name:

* Child First and last name:

* Address:

* Date of birth

* Gender:

* City:

* State:

* Zip:

* Phone:

* Email:

Screening Date Requested

Screening Time Requested
* Indicates Required fields.

705 North Section Avenue, Spring Valley, MN 55975
Phone (507) 346-7276 | Fax (507) 346-7278

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