ConnectEd Forms

We are always happy to speak with interested families regarding services that are available at the clinic.  You may contact us by filling out a request on the contact page. Please note it may take up to 5 business days to respond.

If you are interested in joining our ConnectEd family, please fill out and return the Enrollment and Acknowledgement forms to us via email (shlomit@connected.us.com) or snail mail (return to 1118 Meridian Ave. San Jose, CA. 95025).  Upon receipt, we will be in touch to discuss how ConnectEd can best support your family.

Enrollment Form

Acknowledgment and Signature Form

Please review the following two forms and keep for your own files

Fees (Updated 3/2019)

ConnectEd Photo Release