TherapyWorks Get Started Form | Pediatric SLP, PT, OT

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We specialize in providing high-quality pediatric speech, occupational, physical, and feeding therapies. Our focus on evidence-based, goal-driven treatment and the right match between child and therapist ensures effective therapy. Complete the form to get started with our placement process. Let us help your child thrive!
Your Name*
First Last

Email*

I am looking for a…*
- Speech Therapist
- Physical Therapist
- Occupational Therapist
- Feeding Therapist
- Not Sure

Child's Name
First Last

Child's Birth Date
MM slash DD slash YYYY

Child's Gender
- Boy
- Girl
- Other

Phone*

Location*
City State

Are you looking for In-Home Therapy or Teletherapy?*
- In-Home Therapy
- Teletherapy
TherapyWorks does not yet provide in-home services in your state. We would love to work with your child via teletherapy.

Description

Schedule

Would you like to receive an email with your insurance coverage and cost information?*
- Yes, see insurance information below.
- Yes, but I don’t have my insurance information handy. Please follow up with me and I will provide it later.
- I will not be using insurance. Please send me the private pay rates.
- No
Insurance Name
Primary Insured Name
Primary Insured DOB
Member ID
Group ID
Insurance Phone Number

How did you hear about us?
- Friend/Family or Word of Mouth
- Pediatrician
- Hospital Referral List
- Therapist
- Autism Assistant
- Internet Search
- Roots Autism Solutions
- CITY of Support
- Other

We are committed to protecting your personal information and your right to privacy. Please read our privacy policy for more information on how we handle your data and use it to respond to your request.*
- I accept the Privacy Policy.
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Email
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