Ready to take the first step? Our intake form is quick to complete and gets your child on our referral list right away.
Prepare the following
Your insurance card
Any referrals or authorizations you have already received from your insurance or pediatrician
Your child's diagnosis, if one has been given
Your pediatrician's name
At the end of the form, you will find a secure link to submit a copy of your insurance card. Please use that link rather than attaching your card directly to the form, as this keeps your private health information protected.