Please fill out the form below completely to start the Pre-Enrollment process.

After receiving your child's pre-enrollment form and diagnostic records, one of our intake coordinators will verify your insurance benefits. Completing this forms is not a guarantee of coverage of services, neither is verification from your insurance company. If at any time if insurance does not pay for services, the costs for services are the responsibility of the patient or patient's guardian. We ACCEPT cash paying clients. We DO NOT ACCEPT Medicaid at this time.

Your Information
Your Child's Information
Patient Insurance Information