Referrals from Parents/Other

Process for Referrals

  • Complete our Referral Form below or contact one of our clinics.
  • Our staff will obtain a physician’s signed request for an evaluation for treatment.
  • Medicaid and/or private insurance benefits will be verified.
  • Client’s caregiver/parent will be reached by phone to schedule the initial visit.
  • After the initial visit for an evaluation, the evaluating therapist will recommend the frequency of services and assist the family with scheduling appointments.

Referral Form

Please let us know how we can help you! Fill out the form below and we will contact you shortly.

Child's Name*





Southwest - 8021 Bissonnet
West - 9432 Katy Freeway
Pasadena - 3801 Vista
North - 5206 Airline Dr.
Home Health Therapy

Physical Therapy
Occupational Therapy
Speech Therapy
Other

Parents Name*







Parent
Teacher
Other

Name*